School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
Hong Kong Med J. 2012 Aug;18(4 Suppl 4):1-23.
This report presents the latest estimates of Hong Kong domestic health spending for financial years 1989/90 to 2008/09, cross-stratified and categorised by financing source, provider and function. Total expenditure on health (TEH) was HK$84,391 million in financial year 2008/09, which represents an increase of HK$5030 million or 6.3% over the preceding year. Amid the financial tsunami in late 2008, TEH grew faster relative to gross domestic product (GDP) leading to a marked increase as a percentage of GDP from 4.8% in 2007/08 to 5.1% in 2008/09. During the period 1989/90 to 2008/09, TEH per capita (at constant 2009 prices) grew at an average annual rate of 4.9%, which was faster than that of per capita GDP by 2.0 percentage points. 6.4% when compared with 2007/08, reaching HK$41 257 million and HK$43 134 million, respectively. Consequently, public and private shares of total health expenditure remained the same in the 2 years at 48.9% and 51.1%, respectively. Regarding private spending, the most important source of health financing was out-of-pocket payments by households (35.4% of TEH), followed by employer-provided group medical benefits (7.5%) and private insurance (6.4%). During the period, a growing number of households (mostly in middle to high-income groups) subscribed to pre-payment plans for financing health care. As such, private insurance has taken on an increasingly important role for financing private spending. Of the HK$84 391 million total health expenditure in 2008/09, current expenditure comprised HK$81 186 million (96.2%), whereas HK$3206 million (3.8%) was for capital expenses (ie investment in medical facilities). Analysed by health care function, services for curative care accounted for the largest share of total health spending (66.1%), which was made up of ambulatory services (32.8%), in-patient curative care (28.8%), day patient hospital services (3.9%) and home care (0.5%). Notwithstanding the small share of total spending for day patient hospital services, there was an increasing trend over the period 1989/90 to 2008/09, likely as a result of policy directives to shift the emphasis from inpatient to day patient care. 1989/90 to 46.8% in 2002/03 and then dropped slightly to 43.1% in 2007/08, which was primarily driven by reduced expenditure of Hospital Authority. Compared with the preceding year, expenditure on hospitals increased by HK$2935 million in 2008/09, whereas the corresponding increase for providers of ambulatory health care was only HK$919 million. As a result, the hospital share rebounded a little to 44.0% of total health spending, whereas that of providers of ambulatory health care dropped to 29.1%. Without taking into account capital expenses (ie investment in medical facilities), public current expenditure on health amounted to HK$39 301 million (48.4% of total current expenditure) in 2008/09 with the remaining HK$41 885 million made up from private sources. Public current expenditure was mostly incurred at hospitals (76.1%), whereas private current expenditure was mostly incurred at providers of ambulatory health care (48.9%). Although both public and private spending were mostly expended on personal health care services and goods (91.8% of total current spending), the patterns of distribution among functional categories differed. Public expenditure was targeted at in-patient care (51.8%) and substantially less on out-patient care (25.1%). In comparison, private spending was mostly concentrated on out-patient care (42.6%), whereas in-patient care (23.4%) and medical goods outside the patient care setting (22.5%) accounted for the majority of the remaining share. Compared to the Organisation for Economic Cooperation and Development countries, Hong Kong has devoted a relatively low percentage of GDP to health care in the last decade. As a share of total spending, public funding (either general government revenue or social security funds) in Hong Kong was also lower than that in most economies with comparable economic development and public revenue collection base.
本报告载列香港历年的本地健康开支最新估计数字,按供款来源、服务提供者及功能分项划分。在 2008-09 财政年度,本地健康总开支为 843.91 亿港元,较对上一年增加 50.30 亿港元,增幅为 6.3%。在 2008 年底爆发金融海啸期间,本地健康总开支的增长较本地生产总值(本地生产总值)为快,以致占本地生产总值的百分比由 2007-08 年度的 4.8%上升至 2008-09 年度的 5.1%。在 1989-90 年度至 2008-09 年度期间,以 2009 年不变价格计算的人均本地健康开支以每年平均 4.9%的速度增长,较人均本地生产总值的增长快 2.0 个百分点。2007-08 年度分别为 4125.7 亿港元及 4313.4 亿港元。因此,公共及私人分担的本地健康总开支在这两年维持不变,分别占 48.9%及 51.1%。至于私人开支方面,最大的本地健康开支来源是住户的自费开支(占本地健康总开支的 35.4%),其次是雇主提供的团体医疗福利(7.5%)及私人保险(6.4%)。在这段期间,愈来愈多的住户(主要是在中至高入息组别)购买医疗融资预付计划。因此,私人保险在资助私人开支方面的作用日益重要。在 2008-09 年度的 8439.1 亿港元本地健康总开支中,经常开支占 8118.6 亿港元(96.2%),而资本开支(即医疗设施投资)则占 320.6 亿港元(3.8%)。按医疗服务功能分析,治疗服务占本地健康总开支的最大份额(66.1%),当中包括门诊服务(32.8%)、住院治疗(28.8%)、日间住院服务(3.9%)及住院服务(0.5%)。尽管日间住院服务占本地健康总开支的份额很小,但由 1989-90 年度至 2008-09 年度呈上升趋势,可能是政策重点由住院治疗转移至日间病人护理所致。2002-03 年度占 46.8%,然后在 2007-08 年度略降至 43.1%,主要是由于医院管理局的开支减少。与前一年相比,2008-09 年度医院的开支增加了 29.35 亿港元,而门诊服务提供者的相应增幅仅为 9.19 亿港元。因此,医院的份额略有回升,占本地健康总开支的 44.0%,而门诊服务提供者的份额则下降至 29.1%。不计及资本开支(即医疗设施投资),2008-09 年度公共卫生经常开支为 3930.1 亿港元(占经常开支总额的 48.4%),其余 3188.5 亿港元来自私营部门。公共经常开支主要用于医院(76.1%),而私营经常开支主要用于门诊服务提供者(48.9%)。尽管公共和私人支出主要用于个人医疗保健服务和商品(占经常开支总额的 91.8%),但功能类别之间的分布模式有所不同。公共支出针对住院病人护理(51.8%),而门诊病人护理(25.1%)的支出则相对较少。相比之下,私人支出主要集中在门诊护理(42.6%),而住院病人护理(23.4%)和病人护理以外的医疗用品(22.5%)则占其余大部分。与经济合作与发展组织国家相比,香港在过去十年中用于医疗保健的国内生产总值比例相对较低。就占总开支的份额而言,香港的公共资金(不论是一般政府收入还是社会保障资金)也低于大多数具有可比经济发展和公共收入基础的经济体。
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