• K Y K Tin, P K O Tsoi, Y H Lee, E L H Tsui, D W S Lam, A Y T Yeung, A W M Chui, and M S M Tay.
• School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong.
• Hong Kong Med J. 2013 Dec 1;19(6 Suppl 7):1-24.

AbstractThis report presents the latest estimates of Hong Kong domestic health spending for financial years 1989/90 to 2010/11, cross-stratified and categorised by financing source, provider, and function.Total expenditure on health (TEH) was HK$93 433 million in financial year 2010/11, which represents an increase of HK$5364 million or 6.1% over the preceding year. As a result of a gradual recovery from the financial tsunami in 2008, gross domestic product (GDP) grew faster relative to TEH leading to a drop in TEH as a percentage of GDP from 5.2% in 2009/10 to 5.1% in 2010/11.During the period 1989/90 to 2010/11, TEH per capita (at constant 2011 prices)grew at an average annual rate of 4.8%, which was faster than the average annual growth rate of per capita GDP by 1.8 percentage points.Compared to 2009/10, in 2010/11 public and private expenditure on health increased by 3.7% and 8.5% and reached HK$45 491 million and HK$47 943 million, respectively. Consequently, the public share of TEH dropped slightly from 49.8% to 48.7% over the year. Regarding private spending, the most important source was out-of-pocket payments by households (35.0% of TEH),followed by employer-provided group medical benefits (7.4%), and private insurance (7.2%). It is worth noting that private insurance will likely overtake employer benefits as the second largest private payer if the insurance market continues to expand at the current rate.Of the HK$93 433 million TEH in 2010/11, HK$88 987 million (95.2%) was current expenditure and HK$4446 million (4.8%) was for capital expenses (ie investment in medical facilities). Analysed by health care function, services for curative care accounted for the largest share of TEH (65.8%), which was made up of ambulatory services (34.0%), in-patient curative care (27.0%), day patient hospital services (4.2%), and home care (0.5%). Notwithstanding its small share,the total spending for day patient hospital services shows an increasing trend over the period 1989/90 to 2010/11, which is likely due to shift of policy directives from in-patient to day patient care, and the increasing demand for dialysis and cataract surgery in an ageing population.Hospitals accounted for an increasing share of TEH, from 28.2% in 1989/90 to 46.8% in 2002/03 and then dropped slightly to 43% to 44%during the period 2005/06 to 2010/11, which was primarily driven by reduced expenditure by the Hospital Authority. As a result of several epidemics (e g avian flu, SARS, swine flu) and expansion of the private health insurance market in the last two decades, spending on the provision and administration of public health programmes, and general health administration and insurance accounted for increasing, though less significant, shares of TEH over that period.Without taking into account capital expenses (ie investment in medical facilities), public current expenditure on health amounted to HK$42 264 million(47.5% of total current expenditure) in 2010/11. The remaining HK$46 723 million was from private sources. Public current expenditure was mostly incurred at hospitals (74.7%), whereas private current expenditure was mostly incurred at providers of ambulatory health care (51.0%). Although both public and private spending were mostly expended on personal health care services and goods (91.4%of total current spending), the distributional patterns among functional categories differed. Public expenditure was targeted at in-patient care (47.6%) and substantially less on out-patient care (27.5%). In comparison, private spending was mostly concentrated on out-patient care (43.2%),whereas in-patient care (24.5%) and medical goods outside the patient care setting (19.9%) accounted for most 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 healthcare in the last decade. As a share of TEH, public funding(either general government revenue or social security funds) was also lower than in most economies with comparable economic development and public revenue collection base.

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