HKJC Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong.
Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong.
Int J Health Policy Manag. 2017 Mar 1;6(3):155-164. doi: 10.15171/ijhpm.2016.108.
Ageing has become a serious challenge in Hong Kong and globally. It has serious implications for health expenditure, which accounts for nearly 20% of overall government expenditure. Here we assess the contribution of ageing and related factors to hospitalisation days in Hong Kong. We used hospital discharge data from all publicly funded hospitals in Hong Kong between 2001 and 2012.
A decomposition method was used to examine the factors that account for the change of total hospitalisation days during the two periods, 2001-2004 and 2004-2012. The five factors include two demographic factors - population size and age-gender composition - and three service components - hospital discharge rate, number of discharge episodes per patient, and average length of stay (LOS) - which are all measured at age-gender group level. In order to assess the health cost burden in the future, we also project the total hospitalisation days up to 2041, for a range of scenarios.
During the decreasing period of hospitalisation days (2001-2004), the reduction of LOS contributed to about 60% of the reduction. For the period of increase (2004-2012), ageing is associated with an increase in total hospitalisation days of 1.03 million, followed by an increase in hospital discharge rates (0.67 million), an increase in the number of discharge episodes per patient (0.62 million), and population growth (0.43 million). The reduction of LOS has greatly offset these increases (-2.19 million days), and has become one of the most significant factors in containing the increasing number of hospitalisation days. Projected increases in total hospitalisation days under different scenarios have highlighted that the contribution of ageing will become even more prominent after 2022.
Hong Kong is facing increasing healthcare burden caused by the rapid increase in demand for inpatient services due to ageing. Better management of inpatient services with the aim of increasing efficiency and reducing LOS, avoidable hospitalisation and readmission, without compromising patient satisfaction and quality of service, are crucial for containing the rapid and enormous increases in total hospitalisation days for Hong Kong. The results would be relevant to many rapidly ageing societies in this region.
老龄化已成为香港乃至全球的严峻挑战。老龄化对医疗支出产生了重大影响，医疗支出占政府总支出的近 20%。本研究旨在评估老龄化及相关因素对香港住院日的影响。我们使用了香港所有公立医院 2001 至 2012 年的住院数据。
采用分解法分析了两个时期（2001-2004 年和 2004-2012 年）住院总日数变化的影响因素。这五个因素包括两个人口因素（人口规模和年龄性别构成）和三个服务因素（出院率、每位患者出院次数和平均住院日），所有因素均按年龄性别组进行测量。为了评估未来的医疗费用负担，我们还根据一系列假设方案预测了截至 2041 年的总住院日数。
在住院日减少的时期（2001-2004 年），平均住院日的减少约占减少量的 60%。在住院日增加的时期（2004-2012 年），老龄化导致总住院日增加 103 万天，其次是出院率增加（67 万天）、每位患者出院次数增加（62 万天）和人口增长（43 万天）。平均住院日的减少大大抵消了这些增加（减少了 219 万天），并成为控制住院日增加的最重要因素之一。不同方案下总住院日增加的预测结果突出表明，2022 年后老龄化的影响将更加显著。
由于老龄化导致对住院服务需求迅速增加，香港面临着日益增长的医疗保健负担。为了控制香港总住院日的快速增长，需要更好地管理住院服务，提高效率，减少平均住院日、避免住院和再入院，并在不影响患者满意度和服务质量的情况下，对老龄化问题进行妥善管理。这些结果对于该地区许多老龄化迅速的社会具有借鉴意义。
