A.
ESTIMATES OF HEALTH  EXPENDITURE : 1989/90 - 2015/16

B. WHAT ARE NATIONAL (OR DOMESTIC) HEALTH ACCOUNTS?

C. DEFINITION OF HEALTH EXPENDITURE

D. CLASSIFICATION SYSTEM FOR HONG KONG'S DHA

 

A. ESTIMATES OF HEALTH EXPENDITURE : 1989/90 – 2015/16

Summary results:

Based on the guidelines of A System of Health Accounts 2011 (SHA 2011) published collaboratively by the Organisation for Economic Co-operation and Development (OECD), Eurostat and World Health Organization (WHO), the Food and Health Bureau has updated the estimates of health expenditure in Hong Kong to the position of fiscal year 2015/16.

The major trend and pattern in breakdown by financing scheme, provider and function in accordance to SHA 2011 are summarised below.

(a) Health expenditure (Tables 1.1 – 1.2 and Figures 1.1 – 1.2)
 
1.
 

Total health expenditure amounted to $147,597 million in 2015/16, with annual per capita spending at $20,243.

  2.
From 1989/90 to 2015/16, total health expenditure rose at an average annual rate of 5.9% in real terms, faster than the corresponding increase of 3.8% in Gross Domestic Product (GDP) during the same period. As a result, total health expenditure as a percentage of GDP went up from 3.6% in 1989/90 to 6.1% in 2015/16.
  
     
(b) Health financing schemes (Tables 2.1 – 2.4 and Figures 2.1 – 2.5)
  1.
The increase in total health expenditure from 1989/90 to 2015/16 (342% cumulatively in real terms) was largely driven by the public health expenditure, which soared by 458% cumulatively during the period. This well exceeded the corresponding increase of 264% for private health expenditure.
 
  2.

The public share in total health expenditure went up from 40% in 1989/90 to 51% in 2015/16. Public health expenditure as a percentage of GDP increased from 1.5% to 3.1% during the same period.

  3.
The private share in total health expenditure went down from 60% in 1989/90 to 49% in 2015/16. Yet, private health expenditure as a percentage of GDP grew moderately from 2.2% to 3.0% during the period.
 
  4.
Analysed by financing scheme, 50% of the current health expenditure was paid via the government schemes, 35% was by household out-of-pocket payment in 2015/16. Payment via privately purchased insurance schemes and employer-based insurance schemes taken together accounted for 15% in 2015/16. Over the past decade or so, the share attributed to privately purchased insurance schemes had shown a distinct uptrend.
 
     
(c) Health care providers (Tables 3.1 – 3.3 and Figure 3.1)
  1.
Analysed by provider, spending at providers of ambulatory health care and at hospitals taken together persistently accounted for more than 70% of current health expenditure. In 2015/16, the share was 75%.

 

  2.
However, the trend for health expenditure at providers of ambulatory health care and at hospitals was diverse. Spending at providers of ambulatory health care as a share of current health expenditure had decreased gradually from 42% in 1989/90 to 25% in 2015/16. On the other hand, the faster increase in spending at hospitals led to a rise in the hospital share of current health expenditure from 34% to 50% during the same period.
 
  3.
Public health expenditure was mostly incurred at hospitals, which accounted for 73% of public current health expenditure in 2015/16. Whereas private health expenditure was mostly incurred at providers of ambulatory health care and hospitals, which accounted for 41% and 27% of private current health expenditure respectively in 2015/16.
 
     
(d) Health care functions (Tables 4.1 – 4.5 and Figure 4.1)
  1.
Analysed by health care function, the two largest components of current health expenditure were persistently outpatient curative care (32% – 44%) and inpatient curative care (23% – 30%) during the period from 1989/90 to 2015/16. In 2015/16, their respective shares stood at 34% and 29%.
 
  2.
Public current health expenditure was mostly incurred in inpatient curative care and outpatient curative care, with respective shares of 34% and 26% in 2015/16. Private current health expenditure was concentrated in outpatient curative care, inpatient curative care and medical goods with respective shares of 42%, 24% and 18%.
 
     
(e) Comparison with other economies (Table 5.1)
  1.
Amongst the places with similar economic development, Hong Kong’s healthcare system affords service quality and health outcome that fare well by global standards at relatively low current expenditure on health and public current health expenditures as percentages of GDP (5.9% and 2.9% respectively in 2015/16), indicating cost efficiency and effectiveness.
 
  2.
The ratio of Hong Kong’s public health expenditure to GDP should also be considered in conjunction with her low tax regime. The public health expenditure as a percentage of total tax revenue in Hong Kong is comparable to other economies somewhere in the middle amongst the places with similar economic development.
 
     
(f) Further detailed tabulations
  1.
More detailed cross-tabulations of current health expenditure by financing scheme, provider and function are presented in Tables 6.1 – 6.4.
 

 

 

B. WHAT ARE NATIONAL (OR DOMESTIC) HEALTH ACCOUNTS?

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National or domestic health accounts (NHA/DHA) are descriptive accounts that describe systematically and accurately the totality of health care expenditure flows in both the public and private sectors.

  • NHA/DHA show the amount of funds provided by major sources (e.g. government, firms, households), and how these funds are used in the provision of final services, organised according to the institutional entities providing the services (e.g. hospitals, outpatient clinics, pharmacies, traditional medicine providers) and types of services (e.g. inpatient and outpatient care, dental services, medical research, etc.).

  • In technical terms, NHA/DHA are a set of tables in which various aspects of an economy’s health expenditure are arrayed. Rigorous and standardised classifications of the types and purposes of all expenditures and of all the actors in the health system are adopted in NHA/DHA. NHA/DHA complement other reporting systems to provide a more complete picture of the performance of the health system. A notable example of how NHA/DHA has been deployed in practice is the World Health Report 2000 on the international comparisons of health systems. A principal goal for developing health accounts is to support health system governance and decision-making as the World Health Report argues and shows.

  • On the whole, NHA/DHA provide essential data for health sector planning and management, in the same way the national income accounts and population estimates provide essential data for macroeconomic planning and social service planning respectively.

 

C. DEFINITION OF HEALTH EXPENDITURE

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  • Health expenditures are defined as payment for activities with their primary or predominant purpose of improving, maintaining and preventing the deterioration of the health status of persons and mitigating the consequences of ill-health through the application of qualified health knowledge.

  • Health includes both the health of individuals as well as of groups of individuals or population. Health expenditure consists of all expenditures or outlays for the following health care activities:
    - Health promotion and prevention
    - Diagnosis, treatment, cure and rehabilitation of illness
    - Caring for persons affected by chronic illness
    - Caring for persons with health-related impairment and disability
    - Palliative care
    - Providing community health programmes
    - Governance and administration of the health system



D. CLASSIFICATION SYSTEM FOR HONG KONG'S DHA

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a. Health Care Financing Schemes (HFS)

  • Health care financing schemes are structural components of health care financing systems: they are the types of financing arrangements through which people obtain health services. Health care financing schemes include direct payments by households for services and goods and third-party financing arrangements. Third party financing schemes are distinct bodies of rules that govern the mode of participation in the scheme, the basis for entitlement to health services and the rules on raising and then pooling the revenues of the given scheme.

  • The classification of health care financing schemes is listed below:
HFS.1   Government schemes and compulsory contributory health care financing schemes
  HFS.1.1   Government schemes
    HFS.1.1.1
  Government schemes excluding medical benefits for civil servants and Hospital Authority staff
    HFS.1.1.2   Medical benefits for civil servants and Hospital Authority staff
  HFS.1.2   Compulsory contributory health insurance schemes
  HFS.1.3   Compulsory medical savings accounts
       
HFS.2   Voluntary health care payment schemes
  HFS.2.1   Voluntary health insurance schemes
    HFS.2.1.1   Employer-based insurance schemes
    HFS.2.1.2   Privately purchased insurance schemes
  HFS.2.2   Non-profit institutions serving households financing schemes
  HFS.2.3   Enterprise financing schemes
    HFS.2.3.1   Enterprises (except health care providers) financing schemes
    HFS.2.3.2   Health care providers financing schemes
         
HFS.3   Household out-of-pocket payment
  HFS.3.1   Out-of-pocket excluding cost-sharing
  HFS.3.2   Cost sharing with third-party payers
    HFS.3.2.1   Cost sharing with government schemes and compulsory contributory health insurance schemes
     HFS.3.2.2   Cost sharing with voluntary insurance schemes
     
HFS.4   Rest of the world financing schemes

 

b. Revenues of Health Care Financing Schemes (RFS)

  • Revenue is an increase in the funds of a health care financing scheme, through specific contribution mechanisms. The categories of the classification are the particular types of transaction through which the financing schemes obtain their revenues.

  • Types of revenues of health care financing schemes are used to identify, classify and measure the mix of revenue sources for each financing scheme (for example, social security contributions used to fund the purchases by social security schemes and grants to sustain the non-profit organisation schemes).

  • As financing scheme measures “who manages the health funds” whereas revenue of financing scheme measures “who pays the health funds”, the latter is a better measure on the shares of public and private expenditures in the health sector.

  • The classification of revenue of health care financing schemes is listed below:
RFS.1   Transfers from government domestic revenue
  RFS.1.1   Internal transfers and grants
  RFS.1.2   Transfers by government on behalf of specific groups
  RFS.1.3   Subsidies
  RFS.1.4   Other transfers from government domestic revenue
       
RFS.2   Transfers distributed by government from non-domestic origin
         
RFS.3   Social insurance contributions
  RFS.3.1   Social insurance contributions from employees
  RFS.3.2   Social insurance contributions from employers
  RFS.3.3   Social insurance contributions from self-employed
  RFS.3.4   Other social insurance contributions
       
RFS.4   Compulsory prepayment (other than RFS.3)
  RFS.4.1   Compulsory prepayment from individuals/households
  RFS.4.2   Compulsory prepayment from employers
  RFS.4.3   Other compulsory prepaid revenues
     
RFS.5   Voluntary prepayment
  RFS.5.1   Voluntary prepayment from individuals/households
  RFS.5.2   Voluntary prepayment from employers
  RFS.5.3   Other voluntary prepaid revenues
     
RFS.6   Other domestic revenues not elsewhere classified
  RFS.6.1   Other revenues from households not elsewhere classified
  RFS.6.2   Other revenues from corporations not elsewhere classified
  RFS.6.3   Other revenues from non-profit institutions serving households not elsewhere classified
       
RFS.7   Direct transfers from rest of the world


c. Health Care Providers (HCP)

  • Health care providers are defined as institutional entities that produce and provide health care goods and services, which benefit individuals, groups of individuals or whole populations.

  • Where relevant and practical, health care providers are classified into three broad categories: (i) public sector (e.g. government and statutory bodies), (ii) private sector, and (iii) non-governmental organisations. This categorisation is applied over the basic classification system proposed for providers in SHA 2011, by adding an extra digit.

  • Some provider categories, such as private psychiatric hospitals may not be relevant to Hong Kong currently, but are retained to anticipate any possible future developments.

  • The classification of health care providers is listed below:
HCP.1   Hospitals
  HCP.1.1   General hospitals
    HCP.1.1.1   General hospitals: public
    HCP.1.1.2   General hospitals: private
    HCP.1.1.3   General hospitals: NGO
  HCP.1.2   Mental health hospitals
    HCP.1.2.1   Mental health hospitals: public
    HCP.1.2.2   Mental health hospitals: private
    HCP.1.2.3   Mental health hospitals: NGO
  HCP.1.3   Specialised hospitals (other than mental health hospitals)
    HCP.1.3.1   Specialised hospitals (other than mental health hospitals): public
    HCP.1.3.2   Specialised hospitals (other than mental health hospitals): private
    HCP.1.3.3   Specialised hospitals (other than mental health hospitals): NGO
             
HCP.2   Residential long-term care facilities
  HCP.2.1   Long-term nursing care facilities
    HCP.2.1.1   Long-term nursing care facilities: public
    HCP.2.1.2   Long-term nursing care facilities: private
    HCP.2.1.3   Long-term nursing care facilities: NGO
  HCP.2.2   Mental health and substance abuse facilities
    HCP.2.2.1   Mental health and substance abuse facilities: public
    HCP.2.2.2   Mental health and substance abuse facilities: private
    HCP.2.2.3   Mental health and substance abuse facilities: NGO
  HCP.2.9   Other residential long-term care facilities
    HCP.2.9.1   Other residential long-term care facilities: public
    HCP.2.9.2   Other residential long-term care facilities: private
    HCP.2.9.3   Other residential long-term care facilities: NGO
             
HCP.3   Providers of ambulatory health care
  HCP.3.1   Medical practices
    HCP.3.1.1   Offices of western medical practitioners
      HCP.3.1.1.1   Offices of western medical practitioners: public
      HCP.3.1.1.2   Offices of western medical practitioners: private
      HCP.3.1.1.3   Offices of western medical practitioners: NGO
    HCP.3.1.2   Offices of Chinese medical practitioners
      HCP.3.1.2.1   Offices of Chinese medical practitioners: public
      HCP.3.1.2.2   Offices of Chinese medical practitioners: private
      HCP.3.1.2.3   Offices of Chinese medical practitioners: NGO
  HCP.3.2   Dental practices
    HCP.3.2.1   Dental practices : public
    HCP.3.2.2   Dental practices: private
    HCP.3.2.3   Dental practices: NGO
  HCP.3.3   Other health care practitioners
    HCP.3.3.1   Other health care practitioners: public
    HCP.3.3.2   Other health care practitioners: private
    HCP.3.3.3   Other health care practitioners: NGO
  HCP.3.4   Ambulatory health care centres
    HCP.3.4.1   Family planning centres
      HCP.3.4.1.1   Family planning centres: public
      HCP.3.4.1.2   Family planning centres: private
      HCP.3.4.1.3   Family planning centres: NGO
    HCP.3.4.2   Ambulatory mental health and substance abuse centres
      HCP.3.4.2.1   Ambulatory mental health and substance abuse centres: public
      HCP.3.4.2.2   Ambulatory mental health and substance abuse centres: private
      HCP.3.4.2.3   Ambulatory mental health and substance abuse centres: NGO
    HCP.3.4.3   Free-standing ambulatory surgery centres
      HCP.3.4.3.1   Free-standing ambulatory surgery centres: public
      HCP.3.4.3.2   Free-standing ambulatory surgery centres: private
      HCP.3.4.3.3   Free-standing ambulatory surgery centres: NGO
    HCP.3.4.4   Dialysis care centres
      HCP.3.4.4.1   Dialysis care centres: public
      HCP.3.4.4.2   Dialysis care centres: private
      HCP.3.4.4.3   Dialysis care centres: NGO
    HCP.3.4.9   All other ambulatory centres
      HCP.3.4.9.1   All other ambulatory centres: public
      HCP.3.4.9.2   All other ambulatory centres: private
      HCP.3.4.9.3   All other ambulatory centres: NGO
  HCP.3.5   Providers of home health care services
    HCP.3.5.1   Providers of home health care services: public
    HCP.3.5.2   Providers of home health care services: private
    HCP.3.5.3   Providers of home health care services: NGO
             
HCP.4   Providers of ancillary services
  HCP.4.1   Providers of patient transportation and emergency rescue
    HCP.4.1.1   Providers of patient transportation and emergency rescue: public
    HCP.4.1.2   Providers of patient transportation and emergency rescue: private
    HCP.4.1.3   Providers of patient transportation and emergency rescue: NGO
  HCP.4.2   Medical and diagnostic laboratories
    HCP.4.2.1   Medical and diagnostic laboratories: public
    HCP.4.2.2   Medical and diagnostic laboratories: private
    HCP.4.2.3   Medical and diagnostic laboratories: NGO
  HCP.4.9   Other providers of ancillary services
    HCP.4.9.1   Other providers of ancillary services: public
    HCP.4.9.2   Other providers of ancillary services: private
    HCP.4.9.3   Other providers of ancillary services: NGO
             
HCP.5   Retailers and other providers of medical goods
  HCP.5.1   Pharmacies
  HCP.5.2   Retail sellers and other suppliers of durable medical goods and medical appliances
  HCP.5.9   All other miscellaneous sale and other suppliers of pharmaceuticals and medical goods
       
HCP.6   Providers of preventive care
  HCP.6.1   Providers of preventive care: public
  HCP.6.2   Providers of preventive care: private
  HCP.6.3   Providers of preventive care: NGO
             
HCP.7   Providers of health care system administration and financing
  HCP.7.1   Government health administration agencies
    HCP.7.1.1   Government health administration agencies (health and healthcare agencies)
    HCP.7.1.2   Government health administration of health (central administrative overheads)
  HCP.7.2   Social health insurance agencies
  HCP.7.3   Private health insurance administration agencies
  HCP.7.9   Other administration agencies
             
HCP.8   Rest of the economy
  HCP.8.1   Households as providers of home health care
  HCP.8.2   All other industries as secondary providers of health care
  HCP.8.9   Other industries not elsewhere classified
             
HCP.9   Rest of the world

 

  • Health care services can often be provided in a wide range of settings. For example, outpatient treatment of an acute episode of a common infectious disease (such as urinary tract infection) may occur in clinics of speciality hospitals, offices of western medical practitioners or family planning centres. In such cases, the type of service does not coincide with one specific type of provider. Using both the health care functions (HCF) and health care providers (HCP) classification schemes to develop DHA tables adds substantial richness to health expenditure information.

d. Health Care Functions (HCF)

  • Health care functions are defined as goods and services consumed by final users (i.e. households) with a specific health purpose.

  • The first-level categories of the functional classification aim to distribute health consumption according to the type of need of the consumer (e.g. cure, care and prevention). The categories relating to cure, rehabilitation and long-term care are broken down at the second level of classification by a mode-of-provision approach, i.e. inpatient, day care, outpatient and home-based care.

  • The classification of health care functions is listed below:-
HCF.1     Curative care
  HCF.1.1   Inpatient curative care
    HCF.1.1.1   Inpatient curative care (excluding psychiatric care)
    HCF.1.1.2   Inpatient psychiatric curative care
  HCF.1.2   Day curative care
  HCF.1.3   Outpatient curative care
    HCF.1.3.1   General outpatient curative care
    HCF.1.3.2   Dental outpatient curative care
    HCF.1.3.3   Specialised outpatient curative care
      HCF.1.3.3.1   Specialised outpatient curative care (excluding accident and emergency)
      HCF.1.3.3.2   Accident and emergency
  HCF.1.4   Home-based curative care
             
HCF.2   Rehabilitative care
  HCF.2.1   Inpatient rehabilitative care
  HCF.2.2   Day rehabilitative care
  HCF.2.3   Outpatient rehabilitative care
  HCF.2.4   Home-based rehabilitative care
             
HCF.3   Long-term care (health)
  HCF.3.1   Inpatient long-term care (health)
  HCF.3.2   Day long-term care (health)
  HCF.3.3   Outpatient long-term care (health)
  HCF.3.4   Home-based long-term care (health)
             
HCF.4   Ancillary services
  HCF.4.1   Laboratory services
  HCF.4.2   Iimaging services
  HCF.4.3   Patient transportation
             
HCF.5       Medical goods
  HCF.5.1   Pharmaceuticals and other medical non-durable goods
    HCF.5.1.1   Prescribed medicines
    HCF.5.1.2   Over-the-counter medicines
      HCF.5.1.2.1   Over-the-counter western medicines
      HCF.5.1.2.2   Chinese medicines or herbal products for medicinal purposes
    HCF.5.1.3   Other medical non-durable goods
  HCF.5.2   Therapeutic appliances and other medical goods
    HCF.5.2.1   Glasses and other vision products
    HCF.5.2.2   Hearing aids
    HCF.5.2.3   Other orthopaedic appliances and prosthetics (excluding glasses and hearing aids)
    HCF.5.2.9   All other medical durables, including medical technical devices
             
HCF.6   Preventive care
  HCF.6.1   Information, education and counselling programmes
  HCF.6.2   Immunisation programmes
  HCF.6.3   Early disease detection programmes
  HCF.6.4   Healthy condition monitoring programmes
  HCF.6.5   Epidemiological surveillance and risk and disease control programmes
  HCF.6.6   Preparing for disaster and emergency response programmes
             
HCF.7   Governance, and health system and financing administration
  HCF.7.1   Governance and health system administration
  HCF.7.2   Administration of health financing
             
HCF.9   Other health care services not elsewhere classified
             
Memorandum items
Health care related functions
HCF.R.1   Long-term care (social)
  HCF.R.1.1   In-kind long-term social care
  HCF.R.1.2   Long-term social care cash-benefits
             
HCF.R.2   Health promotion with multi-sectoral approach
  HCF.R.2.1   Food and drinking water control
  HCF.R.2.2   Environmental interventions (excluding those related to food and drinking)
  HCF.R.2.3   Other multi-sectoral health promotion

 

 

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Last revision date: 11/10/2018