Leung Gabriel M, Tin Keith Y K, Chan Wai-Sum
Department of Community Medicine and School of Public Health, Faculty of Medicine Building, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, China.
Health Policy. 2007 Apr;81(1):93-101. doi: 10.1016/j.healthpol.2006.05.014. Epub 2006 Jun 27.
To derive actuarial projection estimates of Hong Kong's total domestic health expenditure to the year 2033.
Disaggregating health expenditure by age, sex, unit cost and utilisation level, we estimated future health spending by projecting utilisation (by public/private, inpatient/outpatient care) to reflect demographic changes and associated increase in demand (from higher expectations and greater intensity of care), and then multiplying such by the projected unit costs (incorporating the impact of key cost drivers such as public expectations, technological changes and potential productivity gains) to obtain total expenditure estimates.
The model was most sensitive to the excess health care price inflation rate, i.e. the annual price/cost growth of medical goods and services over and above per capita GDP growth. Population ageing and growth per se, without taking into account related technologic innovation for chronic conditions that particularly afflict older adults, contribute relatively little to overall spending growth. Given the model assumptions, it is possible to limit total health spending to below 10% of GDP by 2033, where the public share would gradually decline from the current 57% to between 46% and 49%.
Expenditure control through global budgeting, technology assessment and demand-side constraints should be considered although their effectiveness remains inconclusive.
得出到2033年香港国内医疗卫生总支出的精算预测估计值。
按年龄、性别、单位成本和使用水平对医疗卫生支出进行分解，我们通过预测使用情况（按公立/私立、住院/门诊护理）来估计未来的医疗卫生支出，以反映人口结构变化和相关的需求增长（源于更高的期望和更高强度的护理），然后将其乘以预测的单位成本（纳入诸如公众期望、技术变革和潜在生产率提高等关键成本驱动因素的影响），以获得总支出估计值。
该模型对医疗保健价格通胀率过高最为敏感，即医疗商品和服务的年度价格/成本增长超过人均国内生产总值增长。人口老龄化和增长本身，若不考虑针对特别困扰老年人的慢性病的相关技术创新，对总体支出增长的贡献相对较小。根据模型假设，到2033年有可能将医疗卫生总支出限制在国内生产总值的10%以下，届时公共支出份额将从目前的57%逐步降至46%至49%之间。
应考虑通过全球预算编制、技术评估和需求侧限制来控制支出，尽管其有效性仍无定论。
