Replies to LegCo questions
LCQ12: Total health expenditure
Following is a question by the Hon Federick Fung and a written reply by the
Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council
today (October 26):
Question:
Regarding the health care expenditure and demand for public and private
out-patient services in Hong Kong, will the Government inform this Council:
(a) of the respective percentages of expenditures on private, public and overall
health care services in the Gross Domestic Product (GDP) in the past five years,
and whether the authorities have compared these figures to those of other
developed countries or regions; if so, of the results; if the results show that
Hong Kong's figures are lower than those in other countries or regions, the
reasons for that;
(b) of the percentage of the expenditure on primary health care in the total
public health care expenditure in each of the past five years; if these figures
have shown a downward trend, the reasons for that; whether it is partly
attributable to the Government not accepting the view that primary health care
can help to reduce public demand for the more expensive secondary and tertiary
health care services;
(c) as the authorities have pointed out, in the consultation paper on the future
service delivery model for the health care system, that if the existing service
models are not reformed, the estimated percentage of the expenditure on health
care services in the tax revenue will increase from the current 22% to more than
50% by 2033, of the relevant assumptions and statistics on which this estimate
is based, and the respective estimated percentages of expenditures on private,
public and overall health care services in GDP by then; and
(d) how the total number of attendances at private specialist and general
clinics in the past five years compares to that at public specialist and general
clinics?
Reply:
Madam President,
(a) The percentage of total health expenditure as a percentage of GDP from
1999/00 to 2001/02 was around 5% (see Table 1). These figures are derived from
the Domestic Health Accounts (DHA) which adopt the International Classification
for Health Accounts (ICHA) developed by the Organization of Economic
Co-operation and Development (OECD) in 2000 in coming up with the figures. All
health expenditures are grouped according to standardised classifications. DHA
can provide a more complete picture of the health expenditure and facilitate
international comparison. However, the DHA data are only available until
2001/02. Figures on health expenditure for 2002/03 and 2003/04 are being
compiled and will be available later. At present, we can only preliminarily
estimate the figures for 2002/03 and 2003/04 based on the public expenditure on
the policy area group of health and the estimates of private consumption
expenditure on medical care and health expenses. The estimated total, public and
private health expenditure as a percentage of GDP in 2002/03 are 5.2%, 2.7% and
2.5% respectively. The corresponding figures in 2003/04 are 5.3%, 2.8% and 2.5%.
Given the different basis for calculation, the figures of these five years are
not directly comparable.
The total health expenditure as a percentage of GDP varies substantially among
selected economies, ranging from 4.3% to 14.6%. The variations are accounted for
by the differences in health care financing sources, modes of provision of
services and efficiency of the health care systems.
Compared with other economies, Hong Kong's total health expenditure as a
percentage of GDP is not particularly high. However, it should be noted that our
public health expenditure is financed mainly by tax. Hong Kong has a low tax
rate when compared to other economies and a narrow tax base. The ratio of our
public health expenditure to our total tax revenue is also among the highest
when compared to other developed economies. For every $100 we have received from
tax revenue, we are spending about $22 on health care.
(b) The scope of public Primary Health Care services is very wide, including
maternal and child health service, student health service, elderly health
service and health promotion activities of the Department of Health, general
out-patient clinics, community nursing service, community psychiatric service
and community geriatric service of the Hospital Authority (HA). At present, the
Administration does not have the costing data for individual service items.
Similar figures are also not available from other countries.
The Administration has always emphasised the importance of primary health care.
As a result, the Administration has in recent years allocated extra resources in
strengthening the public primary health care services, e.g. the setting up of an
integrated computer system for patient registration, consultation, prescription
and dispensary, together with the increase in the number of pharmacists in
general out-patient clinics, and the development of Visiting Medical Officers
scheme in residential care homes for the elderly. In the recent Discussion Paper
"Building a Healthy Tomorrow" released by the Health and Medical Development
Advisory Committee, chaired by the Secretary for Health, Welfare and Food, the
importance of primary health care to the entire medical system and people's
health has been emphasised at great length.
(c) The Administration has since 2003 commissioned the Department of Community
Medicine & Unit for Behavioural Sciences of the University of Hong Kong to
update the DHA. The same Department has also worked closely with the
Administration to project the health expenditure of Hong Kong through 2033,
including the development of best possible assumptions. The assumptions adopted
are as follows:-
* the total government expenditure maintains at a maximum of 20% of GDP;
* 65% of government revenue comes from tax revenue;
* population demographics in 2033 is the same as projected by the Census and
Statistics Department;
* the health care utilisation rate of the public remains at the present level,
and
* a net 1% annual increase in medical cost.
According to the above assumptions, the total health expenditure will stand at
about 10% of GDP in 2033, 6.4% of which will be public spending and 3.6% will be
private spending. The projected increase in public expenditure will amount to
more than two folds from the present 2.8% to 6.4% in 2033. There is therefore a
need to develop new health care financing options to meet the increased
expenditure.
(d) The number of attendances at public general outpatient clinics (GOPCs) and
specialist outpatient departments (SOPDs) for the past 5 years (with
year-on-year comparison) are listed in table 2.
Although a decrease in attendances at the GOPCs is noted, it does not reflect
any reduction of public resources injected into the corresponding service. The
drop in attendances can be accounted for by various factors:-
* After the transfer of GOPCs from the Department of Health to the HA, there has
been much smoother transfer of patients among the different levels of medical
care. HA also put in additional resources at GOPCs to enhance the effectiveness
of service, including the deployment of more pharmacists and establishment of
new nurse clinics, etc. As a result, the need for follow-up consultation has
decreased.
* HA has also implemented a number of measures to improve the quality of GOPCs
services, which include the introduction of 'family medicine' concept at some
GOPCs and the improvement of medical record system for evening sessions to allow
for individual medical records to be kept at clinics. All the above measures
have allowed patients to be seen by doctors for a longer period of time. This
has caused a corresponding reduction in the total number of cases that could be
seen per day but at the same time, these measures have provided more
comprehensive and all-rounded care to patients hence have reduced the need for
follow-up consultation.
* HA has also computerised their registration system which reduces instances
whereby patients attend several GOPCs on the same day.
The Administration does not have statistics on the attendances at private
specialist and general clinics.
Ends/Wednesday, October 26, 2005
Issued at HKT 17:06
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