Session 2 - 3. Sandra Lee - Healthcare service reform ... 9.2% 6% 7% s % of GD 8% Past Health...

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Transcript of Session 2 - 3. Sandra Lee - Healthcare service reform ... 9.2% 6% 7% s % of GD 8% Past Health...

  • Healthcare Service Reform Initiative e Health Record Sharing System :e-Health Record Sharing System :

    Vision, Actions, Lessons and Prognosis

    1

  • Healthcare Reform: Ageing Demographics & Medical Inflation

    2

  • Hong Kong population ill b i idlwill be ageing rapidly

    Population profile in 2009 & 2039p p

    75 - 79 80 - 84

    85 +

    Age group

    Male Female

    Mid 2039

    75 - 79

    80 - 84

    85 +

    Age group

    Male Female

    Mid 2009

    50 54

    55 - 59 60 - 64

    65 - 69 70 - 74

    75 79

    50 54

    55 - 59

    60 - 64

    65 - 69

    70 - 74

    75 79

    30 - 34

    35 - 39 40 - 44

    45 - 49 50 - 54

    30 - 34

    35 - 39

    40 - 44

    45 - 49

    50 - 54

    5 - 9 10 - 14

    15 - 19 20 - 24

    25 - 29

    5 - 9

    10 - 14

    15 - 19

    20 - 24

    25 - 29

    400 300 200 100 0 100 200 300 400

    0 - 4

    Thousands persons 400 300 200 100 0 100 200 300 400

    0 - 4

    Thousands persons

    In 2009 – 1 out of 8 persons was an elderly person. f

    3

    By 2039 – 1 out of 4 persons will be an elderly person.

    Source: Hong Kong Population Projections 2009 -2039, C&SD

  • Hong Kong will see one of the fastest ageing among advanced economiesageing among advanced economies

    Elderly Dependency Ratio of Hong Kong and Selected Economies 550

    450

    500

    550

    ed 1

    5- 64 Japan

    Actual Projection

    350

    400

    450

    pu la

    tio n

    ag e Finland

    Belgium

    250

    300

    pe r 1

    00 0

    po

    150

    200

    rly a

    ge d

    65 +

    Australia Belgium Canada Finland

    50

    100

    m be

    r o f e

    ld er Hong Kong

    Japan Singapore Sw itzerland United Kingdom U it d St t

    Singapore

    Hong Kong

    4

    0

    19 96

    19 98

    20 00

    20 02

    20 04

    20 06

    20 08

    20 10

    20 12

    20 14

    20 16

    20 18

    20 20

    20 22

    20 24

    20 26

    20 28

    20 30

    20 32

    N um United States

  • The elderly population has greater healthcare needs

    The elderly population uses on average six times more in-patient

    greater healthcare needs y p p g p

    care than the population aged below 65. 12,000

    A b f bli h it l

    8 000

    10,000

    00 0

    pe rs

    on s Average number of public hospital

    bed days utilized by age (2007)

    6,000

    8,000

    ed d

    ay s

    pe r

    1, 0

    2 000

    4,000

    ve ra

    ge n

    o. o

    f b e

    0

    2,000

    20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84 85 +

    A v

    5Source: Data from Hospital Authority

    Age group

  • Everywhere health expenditure is i f t th thgrowing faster than the economy

    Average annual real growth rate of total health expenditure and real

    8%te

    Average annual real growth rate of total health expenditure and real growth rate of GDP in HKG and selected economies (1995-2004)

    5% 6% 7%

    l g ro

    w th

    ra t

    Average annual real growth rate of GDP Average annual real growth rate of total health expenditure

    2% 3% 4%

    ra ge

    a nn

    ua l

    0% 1%

    Japan Switzerland UK USA HKG Australia Singapore

    A ve

    r

    Japan Switzerland UK USA HKG Australia Singapore Source: OECD Health Data 2008 (Jun 2008); WHO – NHA Series; Singapore Ministry of Health; Statistics Singapore; HKDHA: 1990-2004.

    Medical Inflation - advance in medical technology, higher public expectation, rising

    6

    gy, g p p , g medical cost -> medical inflation is driving increase in health expenditure everywhere

  • Hong Kong’s health expenditure projected

    Health expenditure as % of GDP 1990 - 2033 to rise as a share of the economy

    p

    9%

    10%

    P Past Projection

    9.2%

    6%

    7%

    8%

    s % o f G D P Past

    Health expenditure in HK in 1990 - 2004

    Projection Health expenditure in HK in 2005 - 2033 Total health expenditure

    4%

    5%

    6%

    n d i t u r e a

    Public health expenditure

    5.3%

    2 9%

    5.5%

    2%

    3%

    a l t h e x p e

    Public health expenditure

    Private health expenditure

    2.9%

    0%

    1%

    1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 2022 2024 2026 2028 2030 2032

    H e

    Source: Hong Kong’s Domestic Health Accounts: 1990 - 2004 Financial projection of Hong Kong’s total expenditure on health from 2004 to 2033

    7

    2004 to 2033: Ageing + Medical Inflation Per capita health expenditure nearly quadruple when per capita GDP will only double

  • Problems in the Existing Healthcare System

    (1) Primary healthcare service not comprehensive(1) Primary healthcare service not comprehensive enough

    (2) Bottlenecks exist in public healthcare service(2) Bottlenecks exist in public healthcare service and long waiting time

    (3) Public private imbalance in healthcare system(3) Public-private imbalance in healthcare system and limited choices for patients

    (4) I ffi i t t ti id d d th t(4) Insufficient protection provided under the current public healthcare safety net

    (5) L k f h i f di l d b t(5) Lack of sharing of medical records between doctors in public and private hospitals

    8

  • Healthcare Reform:Healthcare Reform: Enhancing Services on a Sustainable Basis

    9

  • First Stage: Healthcare Service Reform

    Enhance primary care

    g

    Enhance primary care

    – Primary Care Development Strategy by end 2010

    Promote public-private partnership in healthcare

    – PPP projects being launched progressivelyPPP projects being launched progressively

    Develop electronic health record sharing

    – First stage eHR Programme for sharing by 2013-14

    Strengthen public healthcare safety netg p y

    – Expand Drug Formulary to support patients in need

    O $5 billi i d f i f 10

    Over $5 billion committed for service reform

  • (1) Enhance Primary care(1) Enhance Primary care To put greater emphasis on preventive care, promote healthyTo put greater emphasis on preventive care, promote healthy lifestyle, improve the state of health of people, reduce the need for hospital care.

    D l b i d l f i i→ Develop basic models for primary care services → Establish a family doctor register → Subsidize individuals for preventive carep → Improve public primary care → Strengthen the function of the Department of Health in health

    educationeducation

    11

  • (2) Promote Public-Private Partnership in HealthcarePartnership in Healthcare

    Provide the public with more choices of quality healthcare services and promote healthy competition and collaboration among the public and private sectors → Purchase primary care from the private market→ Purchase primary care from the private market → Subsidize individuals to undertake preventive care in the

    private sectorp → Purchase hospital services from the private market → Pursue hospital development under the PPP model → Set up multi-partite medical centres of excellence → Engage private sector doctors to practise in public

    hospitals on a part-time basis

    12

  • (3) Develop Electronic H lth R d Sh iHealth Record Sharing

    As an infrastructure, electronic health record sharing can effectively enhance continuity of care, facilitate better integration of different h lth i d i i i d li t i ti tihealthcare services, and minimise duplicate investigations → Fund the development of the sharing

    infrastructureinfrastructure → Make available the know-how

    to the private sector → Consider provision of financial

    assistance P t th b fit f h lth d→ Promote the benefits of health record sharing to patients and healthcare professionals

    13

    p

  • (4) Strengthen Public Healthcare Safety NetSafety Net

    To provide better healthcare protection for patients who need to use public healthcare services

    R d iti ti f bli→ Reduce waiting time of public hospital services Improve the coverage of standard→ Improve the coverage of standard public services

    → Explore the idea of a personal limit→ Explore the idea of a personal limit on medical expenses

    → Inject funding into the Samaritan FundInject funding into the Samaritan Fund

    14

  • Healthcare Reform: Enhancing Services on a Sustainable Basis

    First Stage Consultation (2008): Healthcare Service d Fi i R f

    Enhancing Services on a Sustainable Basis

    and Financing Reform – The public support reform in general, but have

    reservations about mandatory supplementary financingy pp y g – Prefer voluntary private health insurance, and choice of

    private healthcare services according to one’s needs – Want more choice and bet