Domestic health expenditure in Hong Kong: 1989/90 to 2001/02

Objective. To estimate the total domestic health expenditure in Hong Kong between fiscal years 1989/90 and 2001/02, with breakdown by financing source, provider, and function over time. Methods. The standard health accounting methods as per the Organisation for Economic Co-operation and Development System of Health Accounts guidelines of 2000 were adopted. Results. Total domestic health expenditure was $68 620 million in the fiscal year 2001/02. In real terms, expenditure grew at an average rate of 7% while gross domestic product increased by 4% during the same period. This indicates a growing share of health spending relative to gross domestic product, from 3.8% in 1989/90 to 5.5% in 2001/02. This upward trend was largely driven by increased public spending that rose 208% in real terms over the period, compared with 76% for private spending. Out-of-pocket payments by households accounted for about 70% of private spending while employers and insurance accounted for 28%. Private insurance plays an increasingly important role in financing private spending whereas household expenditure has shown a corresponding decrease during the period. Expenditure incurred at providers of ambulatory services and hospitals accounted for more than 70% of total health expenditure during the observed period. Hospitals' share of total spending increased by 18%, reaching 45% of total expenditure in 2001/02, whilst the share of providers of ambulatory services reduced to 30% in 2001/02. The two largest functional components of total health expenditure were ambulatory care (35-41%) and in-patient curative care (20-27%). Public spending generally financed in-patient curative care and ambulatory services; private spending was concentrated on ambulatory services and medical goods outside the patient care setting. Conclusion. These data provide important information for the public, policymakers, and researchers to assess the performance of the health care system longitudinally, and to evaluate health expenditure-related policies.published_or_final_versio

Physicians' perceptions towards the impact of and willingness to pay for clinical computerization in Hong Kong

Background and objectives: We evaluated factors associated with physicians' perceptions towards the effects of computers on health care and on current levels of computerization in their practice. We also performed a contingent valuation to quantify physicians' perceived benefits from computerization in a hypothetical ambulatory, solo clinic. Methods: We surveyed 949 representative physicians in Hong Kong by post. Factor analysis was performed to summarize similar items into categories. Multivariable log-linear regression models were employed to assess the relationships between different factor scores and the number of functions computerized. We elicited their willingness-to-pay (WTP) for three defined computer systems using contingent valuation techniques. WTP values were estimated using econometric modeling by both, parametric and geometric methods. Sociodemographic, attitudinal, and practice-related predictors of WTP were estimated through regression analyses. Results: Factor analysis revealed a three-factor solution which explained 53% of total variance. The overall mean score (mean=3.51±0.45) showed a generally positive attitude towards the effects of computers on health care. Respondents with a higher level of computer knowledge had significantly higher mean overall (P=0.002) and factor scores for all three factors (P<0.01). Higher factor scores on the effects of computers on patient care and clinicians (P=0.006) and on the health system (P=0.032) were associated with a higher number of functions computerized. The parametric median WTP values for computerizing administrative, clinical, and both sets of functions were HK$21,205 (US$ 2719), HK$34,231 (US$ 4389), and HK$45,720 (US$ 5862), respectively, which were lower than the estimates obtained from demand curves using the geometric method [HK$43,286 (US$ 5549), HK$59,570 (US$ 7637), and HK$84,623 (US$ 10,849), respectively]. Doctors with higher incomes were willing to pay more to computerize the clinic, with strong dose-response gradients demonstrated. Those who worked in corporate settings were also more likely to accept higher WTP values. Conclusions: Our findings confirm that better knowledge about computers is contributory to a more positive attitude towards the effects of computers on health care, which is in turn significantly associated with higher levels of actual computerization in clinical practice. WTP values represent the likelihood, in monetary terms, of translating doctors' perceived benefits from computerization into investment action. © 2004 Elsevier Ireland Ltd. All rights reserved.link_to_subscribed_fulltex