In-depth cost-effectiveness study of the multidisciplinary risk factor assessment and management programme (RAMP) of the Hospital Authoirty

Conference Theme: Translating Health Research into Policy and Practice for Health of the PopulationParallel Session 3 - Delivery of Health Services: no. S10published_or_final_versio

Hong Kong domestic health spending: Financial years 1989/90 to 2009/10

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Hong Kong domestic health spending: Financial years 1989/90 to 2008/09

published_or_final_versio

Hong Kong domestic health spending: Financial years 1989/90 to 2006/07

This report presents the latest estimates of Hong Kong domestic health spending for fiscal years 1989/90 to 2006/07, cross-stratified and categorised by financing source, provider, and function. Total expenditure on health (TEH) was HK$75 048 million in fiscal year 2006/07, which represents an increase of HK$4405 million or 6.2% over the preceding year. Represented as a percentage of gross domestic product (GDP), TEH increased from 3.6% in 1989/90 to 5.6% in 2003/04 and then decreased to 5.0% by 2006/07. Taking population growth into account, total health spending per capita (at constant 2007 prices) grew at an average annual rate of 5.1%, which was faster than the average annual growth rate of per capita GDP by 2.1 percentage points. In 2006/07, government financing of health expenditure was HK$37 417 million (49.9$37 631 million) in the last decade as a result of the continued growth of private spending (averaging 9.5% per annum in real terms since 2002/03). The second important source of health financing was out-of-pocket payments by households (35.2%), followed by employer-provided medical benefits (7.4%) and private insurance (5.6%). Private insurance has taken on an increasingly important role for financing private spending, whereas household and employer expenditure together has shown a corresponding decrease during the same period. Of the HK$75 048 million total health expenditure in 2006/07, current expenditure comprised HK$71 888 million (95.8%), whereas HK$3161 million (4.2by health care function, services for curative care accounted for the largest share of total health spending (66.2care, private hospitals had increased capital expenditure leading to an observed increase in investment in medical facilities from 2.2Analysed by health care provider, hospitals accounted for the largest share (42.7Not taking into account capital expenses (ie investment in medical facilities), public current expenditure on health amounted to HK$35 437 million (49.3% of total current expenditure) in 2006/07 with the remaining HK$36 451 million made up of private sources of funds. Expenditure on hospital care (HK$32 069 million) was predominately funded by general government revenue (83.8%), whereas that on providers of ambulatory health care (HK$23 201 million) was by private household out-of-pocket payments (67.3%). This reflects the mixed health care economy of Hong Kong, where public hospitals generally account for about 90% of total bed-days and private doctors (including western and Chinese medicine practitioners) provide about 70% of the out-patient care. Although both public and private spending were mostly expended on personal health care services and goods (92.2% of total spending), the distributional patterns among functional categories differed. Public expenditure was targeted at in-patient care (53.3%) and substantially less at out-patient care (24.4%), especially first-contact care. In comparison, private spending was mostly concentrated on out-patient care (48.7%), whereas medical goods outside the patient care setting (22.4%) and in-patient care (18.9%) comprised the majority of the remaining share. Compared to the Organisation for Economic Cooperation and Development countries, Hong Kong has devoted a relatively low percentage of GDP to health care in the last decade. As a share of total spending, public funding (either general government revenue or social security funds) was also lower than in most comparably developed economies, although commensurate with its public revenue collection base.published_or_final_versio

Hong Kong's domestic health spending—financial years 1989/90 through 2004/05

This report presents the latest estimates of Hong Kong’s domestic health spending between fiscal years 1989/90 and 2004/05, cross-stratified and categorised by financing source, provider and function on an annual basis. Total expenditure on health was HK$67 807 million in fiscal year 2004/05. In real erms, total expenditure on health showed positive growth averaging 7This increase was largely driven by the rise in public spending, which rose 9Of the$67 807 million total health expenditure in 2004/05, current xpenditure comprised $65 429 million (96$2378 million (4%) were apital expenses (ie investment in medical facilities). Services of curative care ccounted for the largest share of total health spending (67%) which were made p of ambulatory services (35%), in-patient curative care (28%), day patient ospital services (3%), and home care (1%). The next largest share of total health xpenditure was spent on medical goods outside the patient care setting (10%). Analysed by health care provider, hospitals accounted for the largest share (46%) and providers of ambulatory health care the second largest share (30%) f total health spending in 2004/05. We observed a system-wide trend towards ervice consolidation at institutions (as opposed to free-standing ambulatory linics, most of which are staffed by solo practitioner). In 2004/05, public expenditure on health amounted to $35 247 million (53.9$30 182 million) was mostly incurred at providers of mbulatory health care (54.6%). This reflects the mixed health care economy of ong Kong where public hospitals generally account for about 90% of total beddays nd private doctors (including Western and Chinese medicine practitioners) rovide 75% to 80% of out-patient care. While both public and private spending were mostly expended on personal ealth care services and goods (92.9%), the distributional patterns among functional ategories differed. Public expenditure was targeted at in-patient care (54.2%) and ubstantially less on out-patient care (24.5%), especially low-intensity first-contact are. In comparison, private spending was mostly concentrated on out-patient care (49.6%), whereas medical goods outside the patient care setting (22 .6%) and inpatient are (18.8%) comprised the majority of the remaining share. Compared to OECD countries, Hong Kong has devoted a relatively low percentage of gross domestic product to health in he last decade. As a share of total spending, public funding (either general government revenue or social security funds) was lso lower than in most comparably developed economies, although commensurate with its public revenue collection base.published_or_final_versio

Effects of Patient Empowerment Programme (PEP) on Clinical Outcomes and Health Service Utilization in Type 2 Diabetes Mellitus in Primary Care: An Observational Matched Cohort Study

Background: To evaluate the effects of a large population-based patient empowerment programme (PEP) on clinical outcomes and health service utilization rates in type 2 diabetes mellitus (T2DM) patients in the primary care setting. Research Design and Subjects: A stratified random sample of 1,141 patients with T2DM enrolled to PEP between March and September 2010 were selected from general outpatient clinics (GOPC) across Hong Kong and compared with an equal number of T2DM patients who had not participated in the PEP (non-PEP group) matched by age, sex and HbA1C level group. Measures: Clinical outcomes of HbA1c, SBP, DBP and LDL-C levels, and health service utilization rates including numbers of visits to GOPC, specialist outpatient clinics (SOPC), emergency department (ED) and inpatient admissions, were measured at baseline and at 12-month post-recruitment. The effects of PEP on clinical outcomes and health service utilization rates were assessed by the difference-in-difference estimation, using the generalized estimating equation models. Results: Compared with non-PEP group, PEP group achieved additional improvements in clinical outcomes over the 12-month period. A significantly greater percentage of patients in the PEP group attained HbA1C≤7% or LDL-C≤2.6 mmol/L at 12-month follow-up compared with the non-PEP group. PEP group had a mean 0.813 fewer GOPC visits in comparison with the non-PEP group. Conclusions: PEP was effective in improving the clinical outcomes and reduced the general outpatient clinic utilization rate over a 12-month period. Empowering T2DM patients on self-management of their disease can enhance the quality of diabetes care in primary care.published_or_final_versio

Evaluation of quality of care of Chronic Disease Management Programmes and Public-Private Partnership Programmes of the Hospital Authority

Parallel Session 3 – Delivery of Health Services: no. S12Conference Theme: Translating Health Research into Policy and Practice for Health of the Populationpublished_or_final_versio

Collecting household water usage data: telephone questionnaire or diary?

<p>Abstract</p> <p>Background</p> <p>Quantitative Microbial Risk Assessment (QMRA), a modelling approach, is used to assess health risks. Inputs into the QMRA process include data that characterise the intensity, frequency and duration of exposure to risk(s). Data gaps for water exposure assessment include the duration and frequency of urban non-potable (non-drinking) water use. The primary objective of this study was to compare household water usage results obtained using two data collection tools, a computer assisted telephone interview (CATI) and a 7-day water activity diary, in order to assess the effect of different methodological survey approaches on derived exposure estimates. Costs and logistical aspects of each data collection tool were also examined.</p> <p>Methods</p> <p>A total of 232 households in an Australian dual reticulation scheme (where households are supplied with two grades of water through separate pipe networks) were surveyed about their water usage using both a CATI and a 7-day diary. Householders were questioned about their use of recycled water for toilet flushing, garden watering and other outdoor activities. Householders were also questioned about their water use in the laundry. Agreement between reported CATI and diary water usage responses was assessed.</p> <p>Results</p> <p>Results of this study showed that the level of agreement between CATI and diary responses was greater for more frequent water-related activities except toilet flushing and for those activities where standard durations or settings were employed. In addition, this study showed that the unit cost of diary administration was greater than for the CATI, excluding consideration of the initial selection and recruitment steps.</p> <p>Conclusion</p> <p>This study showed that it is possible to successfully 'remotely' coordinate diary completion providing that adequate instructions are given and that diary recording forms are well designed. In addition, good diary return rates can be achieved using a monetary incentive and the diary format allows for collective recording, rather than an individual's estimation, of household water usage. Accordingly, there is merit in further exploring the use of diaries for collection of water usage information either in combination with a mail out for recruitment, or potentially in the future with Internet-based recruitment (as household Internet uptake increases).</p

Effectiveness of the Multi-disciplinary Risk Assessment and Management Programme (RAMP) on patients with Diabetic Mellitus – the First Year Experience

Oral PresentationConference Theme: Innovations in Primary CareINTRODUCTION: This study aimed to reveal the post 12-month effectiveness of the Multi-disciplinary Risk Assessment and Management Programme (RAMP) on diabetic patients. METHOD: Evaluation involved eleven clinics from four clusters of the Hospital Authority which had started RAMP before June 2010. A random sampling of 1248 patients enrolled into RAMP for more than one year was compared to age-sex, and disease-severity matched non-RAMP controls on clinical outcomes including HbA1c, blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C), and the estimated 10-year cardiovascular disease (CVD) risk using Framingham risk scores equation to reveal the net benefit of RAMP. Independent t-test and Chi-square tests were used for comparison of continuous data and proportions, respectively. RESULTS: Both RAMP and non-RAMP patients showed a reduction in mean HbA1c, blood pressure, and LDL-C; and an increase in proportions of patients achieving target control of HbA1c ≤ 7%, BP ≤ 130/80 mmHg, and LDL-C ≤ 2.6 mmol/L). RAMP group did not show a significant net reduction in HbA1c compared to non-RAMP group but did show a significant net reduction of 2.61 (1.49) mmHg in SBP (DBP), and LDL-C of 0.17 mmol/L. RAMP reduce 10-year CVD risk by 4.66%, which significantly overwhelmed the 2.46% in control group by 2.2%. DISCUSSION: RAMP helped diabetic patients to improve their control of blood glucose, blood pressure, cholesterol level, and reduce their 10-year CVD risk. Significant extra reduction in 10-year CVD risk without net HbA1c reduction supported that the goal of management of diabetic patients should not limited to HbA1c only