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Hong Kong: Hong Kong Health Profile 2012






Hong Kong Health Profile 2012

Ministry of Health's mission, vision and objectives

The mission of the Food and Health Bureau is to enhance the well-being of every member of the community and to build a healthy and caring society, seeking to ensure a good quality, equitable, efficient, cost-effective and accessible health care system, and to organize the infrastructure for coordinated health care delivery through an interface of public and private systems.

The Government’s goal is to provide a health care system that is able to protect and promote health and to provide quality health care services to citizens at reasonable prices.
Organization of health services and delivery systems

Primary health care services, which include a range of health-promotion, preventive and curative services, are provided by the Department of Health, the Hospital Authority and the private sector.

Most health-promotion and preventive services are provided by the public sector. For curative services, private practitioners of Western medicine accounted for more than half (55.6%) of consultations in 2008. Most private practitioners are in solo practices and usually work on a fee-for-service basis. The traditional Chinese medicine practitioner is the principal alternative primary care provider outside the mainstream Western medical system. Many patients use both systems in parallel, taking Western medicine to suppress symptoms and Chinese medicine to restore the body to its natural balance.

In contrast to curative primary care services, the public sector is the dominant provider of secondary and tertiary services. Hospital services are subsidized by the Government to a large extent.

The Department of Health provides a wide range of health-promotion and disease-prevention services, covering programmes on maternal and child health, student health, elderly health, dental health and port health. The Department also operates a number of specialized clinics, including 20 methadone clinics, 19 tuberculosis and chest clinics, seven social hygiene clinics, four dermatology clinics, two integrated treatment centres, four clinical genetics clinics, six child-assessment centres, two travel-health centres and other clinical services. The Centre for Health Protection was set up under the Department of Health to strengthen the prevention and control of communicable diseases and other public health hazards.

The Hospital Authority provides medical treatment and rehabilitation services to patients through public hospitals, general outpatient and specialist clinics and outreach services. The Authority was managing a total of 26 872 hospital beds in 38 public hospitals at the end of 2009, which represents around 3.8* public hospital beds per 1000 population. The Hospital Authority also operates 74 general outpatient clinics throughout the territory, targeted primarily at serving low-income families, patients with chronic diseases and other vulnerable groups.

The private sector plays a complementary role in providing health care, and there were around 3730 private clinics providing primary and specialist medical care in 2009. The Thematic Household Survey, conducted from February 2008 to May 2008, showed that, of a total of 1 806 400 medical consultations (based on the last and up to the last three consultations with doctors made by the persons concerned) during the 30 days before enumeration, 70% (or 1 256 400 consultations) were with private medical practitioners (including practitioners of Western medicine and Chinese medicine). There were 13 private hospitals, operating a total of 3818 hospital beds, at the end of 2009. Their market share in terms of inpatient discharges and deaths on attendance was 21.0%. There were also 37 private nursing homes, providing about 3573 beds, at the end of 2009.

With regard to pharmaceutical services, public hospitals and clinics provide the more essential medicines to patients at a nominal cost. Private hospitals and clinics supply a broader range of medicines, which are paid for by the patients themselves. All medicines available in Hong Kong must first be registered with the Pharmacy and Poisons Board, a statutory body whose membership comprises mainly doctors, academics and pharmacists. All manufacturers of medicines must meet the requirements of the good manufacturing practices (GMP) guidelines promulgated by the Pharmacy and Poisons Board, which are adopted from the GMP guidelines recommended by WHO. Medicines are classified into three broad categories in terms of control of sale: prescription-only medicines, pharmacy medicines and general-sale medicines. There are currently about 20 000 registered medicines in total, of which about 40% are prescription-only medicines, 14% are pharmacy medicines and 46% are general-sale medicines.

Health policy, planning and regulatory framework

The Government’s health care policy is that no one in Hong Kong is deprived of medical care because of lack of means.

The Food and Health Bureau is the policy-making body responsible for health. It oversees the Department of Health and the Hospital Authority. The Department of Health is the Government’s health adviser and the agency responsible for executing health care policies and statutory functions. The Hospital Authority is the statutory body responsible for the management of all public hospitals.

Health care financing
Total health care expenditure in 2005/2006 amounted to 5.1% of GDP, including the public sector (52%) and the private sector (48%). Public expenditure on health reached US$ 4.7 billion. As there are no social security funds, all public finances for health care services come from general government funds.

The health services provided by the public sector are heavily subsidized, with subsidy levels at about 97% of total cost for inpatient services and 84% for general outpatient services in 2008/2009. Health-promotion and disease-prevention activities, such as treatment of tuberculosis and childhood immunization, are provided free of charge.

The private health care sector was financed largely by household out-of-pocket payments (71%) and, to some extent, private insurance (11%) and employer-provided group medical benefits (16%) in 2005/2006.

Human resources for health
Health care manpower is monitored regularly through surveys to ensure that workforce planning is in line with the needs of the community.

The Hong Kong Government also makes projections on health care manpower demand from time to time. When making manpower projections, the views of major employers from both the public and private sectors are taken into account. Advice is given to the University Grants Committee in relation to publicly-funded places on health care programmes, which serves as a reference for institutions in formulating their academic plans.

On the regulatory front, various statutory boards and councils, such as the Medical Council, the Chinese Medicine Council, the Dental Council, and the Pharmacy and Poisons Boards, have been established under relevant ordinances to handle the registration, conduct and discipline of their respective health care professionals. Under existing legislation, 12 types of health care professional are required to be registered with their respective boards or councils before being allowed to practise in Hong Kong. In addition, an independent statutory body, the Hong Kong Academy of Medicine, has the authority to approve, assess and accredit specialist training within the medical and dental professions.

The medical and health care professionals registered with respective statutory boards and councils are encouraged to enrol in continuing medical education and/or continuous professional development (CME/CPD) programmes to update their knowledge and promote the development of competencies relevant to their practice. It is a statutory requirement for registered Chinese medicine practitioners to fulfil the CME programmes of the Chinese Medicine Council in order for them to renew their practising certificates. In 2009, there were a total of 6048 Chinese medicine practitioners. Medical practitioners and dentists on the Specialist Register must fulfil the CME/CPD requirements of their respective councils in order to maintain their specialist status.

Locally, the Government maintains good working relationships and collaborates with various partners, including professional and community associations, in health-promotion activities for the prevention and control of communicable and noncommunicable diseases. For instance, a comprehensive disease notification system is maintained with health care providers and institutions from the public and private sectors. The latest outbreak news and surveillance results are shared and dialogue is maintained among health care providers and professional associations. The Government also partners with the Hospital Authority and voluntary agencies in handling public health emergencies.

On the regional front, close alliances with regional authorities, including the Ministry of Health of the People’s Republic of China, the Health Department of Guangdong Province and the Macao Health Bureau, facilitate regular exchanges of information on selected diseases. Bilateral and multilateral meetings, forums and emergency response exercises are held from time to time to strengthen cooperation and communication among regional authorities. Internationally, the Government liaises closely with WHO and engages in collaborative projects with overseas health-protection agencies and academic institutions.

Challenges to health system strengthening
Over the years, Hong Kong has built an enviable health care system that provides high quality services. However, that system is now facing major challenges due to the ageing population and the need to keep pace with rapid developments in medical technology. The ratio of working-age (between 15 and 64) to elderly populations (65 or above) was 5.9:1 in 2009, and it is estimated that it will be 4.2:1 in 2019 and 2.6:1 in 2029. On the other hand, overall public health expenditure is projected to increase to about US$ 10.0 billion in 2015 and about US$ 16.3 billion in 2025 (at constant 2005 prices). To uphold the principle of no one in Hong Kong being deprived of medical care because of lack of means, the Government of Hong Kong launched a consultation exercise in March 2008 on health care reform and supplementary financing options, aimed at building a consensus to reform the health care system and make it sustainable and more responsive to the increasing needs of the community.