Statistics

Domestic Health Accounts

A. ESTIMATES OF HEALTH EXPENDITURE : 1989/90 - 2019/20

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

D. CLASSIFICATION SYSTEM FOR HONG KONG'S DHA

A. ESTIMATES OF HEALTH EXPENDITURE : 1989/90 – 2019/20

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 2019/20.

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

(a)	Health expenditure (Tables 1.1 – 1.2 and Figures 1.1 – 1.2) Total health expenditure amounted to $189,624 million in 2019/20, with annual per capita spending at $25,258. From 1989/90 to 2019/20, total health expenditure rose at an average annual rate of 5.6% in real terms, faster than the corresponding increase of 3.4% 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 6.8% in 2019/20.
(b)	Health financing schemes (Tables 2.1 – 2.4 and Figures 2.1 – 2.5) The increase in total health expenditure from 1989/90 to 2019/20 (413% cumulatively in real terms) was largely driven by the public health expenditure, which is increased by 578% cumulatively during the period, exceeding the increase of 300% for private health expenditure in the corresponding period. The public share in total health expenditure went up from 40% in 1989/90 to 54% in 2019/20. Public health expenditure as a percentage of GDP increased from 1.5% to 3.6% during the same period. The private share in total health expenditure went down from 60% in 1989/90 to 46% in 2019/20. Yet, private health expenditure as a percentage of GDP grew moderately from 2.2% to 3.1% during the period. Analysed by financing scheme, 53% of the current health expenditure was paid via the government schemes, 30% was by household out-of-pocket payment in 2019/20. Payment via privately purchased insurance schemes and employer-based insurance schemes taken together accounted for 16% in 2019/20. 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) 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 2019/20, the share was 74%. 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 23% in 2019/20. 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 52% during the same period. Public health expenditure was mostly incurred at hospitals, which accounted for 71% of public current health expenditure in 2019/20. Whereas private health expenditure was mostly incurred at providers of ambulatory health care and hospitals, which accounted for 37% and 31% of private current health expenditure respectively in 2019/20.
(d)	Health care functions (Tables 4.1 – 4.5 and Figure 4.1) Analysed by health care function, the two largest components of current health expenditure were persistently outpatient curative care (31% – 44%) and inpatient curative care (23% – 30%) during the period from 1989/90 to 2019/20. In 2019/20, their respective shares stood at 31% and 28%. Public current health expenditure was mostly incurred in inpatient curative care and outpatient curative care, with respective shares of 32% and 26% in 2019/20. Private current health expenditure was concentrated in outpatient curative care, inpatient curative care and medical goods with respective shares of 37%, 24% and 18%.
(e)	Comparison with other economies (Table 5.1) 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 (6.5% and 3.4% respectively in 2019/20), indicating cost efficiency and effectiveness. Hong Kong’s public health expenditure to GDP should also be considered in conjunction with her low tax regime. The public health expenditure, expressed as a percentage of total tax revenue, of Hong Kong ranks the 5th highest among the 15 places with similar economic development.
(f)	Further detailed tabulations 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?

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

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

Hong Kong’s DHA has adopted the International Classification of Health Accounts (ICHA) as set out in A System of Health Accounts 2011.

The ICHA has been designed to be compatible with a number of existing classification schemes and practices in international economic statistics, e.g. national income accounts. In HKDHA, expenditures are classified according to the following four dimensions of analysis:

a. Health care financing schemes
b. Revenues of health care financing schemes
c. Health care providers
d. Health care functions

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