Background: Ageing has become a serious challenge in Hong Kong and globally. It has serious implications for health
expenditure, which accounts for nearly 20% of overall government expenditure. Here we assess the contribution of
ageing and related factors to hospitalisation days in Hong Kong. We used hospital discharge data from all publicly
funded hospitals in Hong Kong between 2001 and 2012.
Methods: A decomposition method was used to examine the factors that account for the change of total hospitalisation
days during the two periods, 2001-2004 and 2004-2012. The five factors include two demographic factors – population
size and age-gender composition – and three service components – hospital discharge rate, number of discharge
episodes per patient, and average length of stay (LOS) – which are all measured at age-gender group level. In order
to assess the health cost burden in the future, we also project the total hospitalisation days up to 2041, for a range of
scenarios.
Results: During the decreasing period of hospitalisation days (2001-2004), the reduction of LOS contributed to
about 60% of the reduction. For the period of increase (2004-2012), ageing is associated with an increase in total
hospitalisation days of 1.03 million, followed by an increase in hospital discharge rates (0.67 million), an increase in
the number of discharge episodes per patient (0.62 million), and population growth (0.43 million). The reduction
of LOS has greatly offset these increases (-2.19 million days), and has become one of the most significant factors
in containing the increasing number of hospitalisation days. Projected increases in total hospitalisation days under
different scenarios have highlighted that the contribution of ageing will become even more prominent after 2022.
Conclusion: Hong Kong is facing increasing healthcare burden caused by the rapid increase in demand for inpatient
services due to ageing. Better management of inpatient services with the aim of increasing efficiency and reducing
LOS, avoidable hospitalisation and readmission, without compromising patient satisfaction and quality of service, are
crucial for containing the rapid and enormous increases in total hospitalisation days for Hong Kong. The results would
be relevant to many rapidly ageing societies in this region