Transition of hospital acute-centric to long term care in an ageing population in Hong Kong - Is it an issue of service gap?

Abstract

Health expenditure at around 5.7% of GDP is low for a developed society like Hong Kong, where a dual track of public and private services in its health care system is unique. The low level of expenditure has been steady over the last three decades, apparently not affected at all by a major change in the Government in 1997. The public and private sections have equal share of the total health dollars consistently over the years, despite the increase of Government's annual spending from 11% to 17% since 1990, implying a similar trend in the private sector, which is funded predominantly by out of the pocket expenses with some insurance contribution. However, Hong Kong has the longest life expectancy in the world. This has resulted in the increase in the demand for health and long-term care, casting doubt on whether the traditional model of financing and delivery of care will be sustainable. The Government has pledged that that no one is denied adequate medical treatment due to lack of means, a stance in existence for decades and being reflected by the steady state of public and private share of health expenditure. Apart from two major re-structuring of the governance system, there has been little change in the service provision organisations. The system is often criticized for being heavily hospital based and acute-centric, particularly in the public services. Primary care is taken up predominantly by the private sector, mostly in clinical services, not focusing on prevention. It is apparent that there is a significant service gap, that needs to be examined and addressed systematically before a practical solution can be formulated. A more holistic, humanistic and better integrated system of care, with innovative care patterns, shall be the way forward.