The Contribution of Ageing to Hospitalisation Days in Hong Kong: A Decomposition Analysis.

Chi Leung Kwok,Carmen Km Lee,Paul Sf Yip,William Tl Lo

doi:10.15171/ijhpm.2016.108

Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: 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.

Highlights

A rapidly ageing demographic is a growing problem for many high- and middle-income countries
We note that the number of hospital beds in Hospital Authority (HA) hospitals decreased by 7.97% between 2002 and 2012.34 As reported by HA, the total hospitalisation days of inpatient discharges and deaths in public hospitals decreased greatly, from 9.46 million in 2001 to 7.66 million in 2004 (Figure 1)
31.38%-35.18% of inpatients, comprising 38.20%-42.00% of discharge episodes and 45.31%-50.52% of total hospitalisation days, were older adults, which is overrepresentative of the population; as of 2012, older adults only made up 13.70% of the population

Summary

Introduction

A rapidly ageing demographic is a growing problem for many high- and middle-income countries. The magnitude and rate of the increases in the demand for healthcare services relating to age-associated medical conditions has left many countries unprepared.. The magnitude and rate of the increases in the demand for healthcare services relating to age-associated medical conditions has left many countries unprepared.13-18 This has placed a significant financial burden on many governments. In Hong Kong, medical and health service expenditures have been increasing and account for 16.8% of recurring government expenditures.19 This figure is high in comparison to most countries and ranks in the top 30% worldwide in terms of public expenditure per capita.. Older patients are generally associated with higher severity of illness, greater complexity and greater comorbidity, leading to longer stays in hospitals and higher hospital costs.1,3,10,15 It is usually the greatest among all healthcare expenditures.. Over 60% will be aged 75 and above.

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Discussion

Conclusion