project partners: funded by: societal age disparities in health care: observation from hk compared...

Project Partners:Funded by:

Societal Age Disparities in Health Care:Observation from HK compared with the UK

B Mak, J Woo, A Bowling, F Wong, PH Chau

2


Ageing Population &Public Health Expenditure

Ageing population in Hong Kong• People over age 65 will increase from 13% in 2009 to 28% in

2039.

• Ageing population will lead to an increase in chronic disease and disability burden on health care system.

Public health expenditure• $37.8 billion in 2004 (14.7% of the total government budget)

• $186.6 billion in 2033 (27.3% of the total government budget)

3


Needs for Prioritization

HK government healthcare budget is unable to keep up with the demand.

Some form of rationing in health services seems to be inevitable.

However, there has been • No official acknowledgement of the needs for prioritization

• Little discussion of this issue among policy makers, professionals and the general public

4


The Present Study

Objectives:• To examine how HK people view health care

prioritization− Older people have a greater health care need than

others.− Prioritize older people / elderly services over others?− Any difference between healthcare professionals and

the public view of prioritization?

• To compare the findings with those from a UK survey (Bowling, 1996)

− Any difference between HK and UK people?

5


Methodology

Survey:• An opinion survey was conducted in HK from January to

November 2009.

Participants:• 1,512 people aged 18+ participated.

− 117 of them were healthcare professionals.

Questionnaire:• The design was based on the one used by Bowling (1996).

6


The Questionnaire (i)

1. Respondents were asked to prioritize 12 health services:− Treatment for children with life threatening illness − Treatment for people aged 75 and over with life threatening illness− Long stay hospital care for elderly people− Special care and pain relief for people who are dying− District nursing and community services / care at home− Treatment for infertility− Psychiatric services for people with mental illness− Surgery, such as hip replacement, to help people carry out everyday tasks− Preventive screening services and immunizations− High technology surgery, organ transplants and procedures which treat life

threatening conditions− Health promotion / education services to help people lead healthy lives− Intensive care for premature babies who weigh less than 680g with only a

slight chance of survival

7


The Questionnaire (ii)

2. Respondents were asked who they thought should set priorities and to select their preference from a list:

− Doctors at local level − Hospital mangers− Hospital Authority− Politicians and the government− The public

8


Results (i)

Priority Ranking of the 12 Health Services :1. Treatment for children

2. High technology surgery3. Preventive screening services4. Surgery to help people carry out everyday tasks5. Health promotion / education services6. Psychiatric services7. District nursing & community services / care at home8. Long stay hospital care for elderly people9. Treatment for people aged >7510. Special care & pain relief for people who are dying11. Intensive care for premature babies12. Treatment for infertility

Healthcare professionals vs. General public

9


Results (ii)

“If resources are to be rationed, higher priority should be given to treating the young rather than the elderly.”

• 44% agreed (vs. 34% disagreed)

“Surveys of the general public’s opinions, like this one, should be used in the planning of health services.”

• 77% agreed

10


Results (iii)

Respondents were asked to rank who should set priorities:

• Doctors at local level (43%)• The public (21%)• Hospital Authority (19%)• Hospital mangers (11%)• Politicians and the government (6%)

“The responsibility for rationing health care should rest with doctors.”


11


UK Results (iii)

“The responsibility for rationing health care should rest with doctors.”


“Surveys of the general public’s opinions, like this one, should be used in the planning of health services.”

• 91% agreed

“If resources are to be rationed, higher priority should be given to treating the young rather than the elderly.”


12


International ComparisonHK UK

Treatment for children 1 1

High technology surgery 2 7

Preventive screening services 3 3

Surgery to help people carry out everyday tasks 4 4

Health promotion / education services 5 8

Psychiatric services 6 6

District nursing and community services 7 5

Long stay hospital care for elderly people 8 10

Treatment for people aged >75 9 12

Special care & pain relief for people who are dying 10 2

Intensive care for premature babies 11 9

Treatment for infertility 12 11

13


International ComparisonHK UK

Treatment for children 1 1

High technology surgery 2 7

Preventive screening services 3 3

Surgery to help people carry out everyday tasks 4 4

Health promotion / education services 5 8

Psychiatric services 6 6

District nursing and community services 7 5

Long stay hospital care for elderly people 8 10

Treatment for people aged >75 9 12

Special care & pain relief for people who are dying 10 2

Intensive care for premature babies 11 9

Treatment for infertility 12 11

14


Discussion (i)

In HK, most people including healthcare professionals give priority to the young over the old in distributing a given amount of health care benefit:

• Services for the elderly, whether in the community or in hospitals, and including end-of-life, were ranked among the lowest.

Most people think that:• General public’s view of prioritization should be used in

the planning of health services.• The responsibility for rationing health care should rest with

doctors.

15


Discussion (ii)

HK health care policy needs to acknowledge constraints and the needs for prioritization

• To meet the needs of ageing societies• To meet the needs of all users equitably

The public and professionals should engage with policy makers in formulating a policy based on:

• Cost benefit considerations• Overall societal view of prioritization that is not based on

age alone

16


Age Disparities in Health Care

Q & A

project partners: funded by: societal age disparities in health care: observation from hk compared...

Documents