Hong Kong 2006

Secondary, tertiary and specialised healthcare services are provided mainly in the hospital setting. As at December 31, 2006, there were 27 755 hospital beds run by the Hospital Authority, comprising 20 238 acute, 2 151 infirmary, 4 666 mentally ill and 700 rehabilitative beds. In addition, there were 3 124 beds in private hospitals, 2 998 in nursing homes and 762 in institutions under the Correctional Services Department. In aggregate, the average number of beds per thousand population is 5.0.

Secondary and tertiary ambulatory services in the public sector are mainly provided through the specialist clinics of the Hospital Authority. At these clinics, patients' symptoms are assessed, and specific investigations will be arranged to facilitate diagnosis, treatment, and follow-up of patients requiring long-term specialist care. In the financial year 2005-06, about $5.6 billion were allocated for the provision of such services. Most public hospitals offer a range of specialty clinics, encompassing Internal Medicine, Surgery, Obstetrics and Gynaecology, Paediatrics, Orthopaedics and Traumatology, Ophthalmology, Ear Nose and Throat, Neurosurgery, Oncology and Cardiothoracic Surgery. Many have also designated subspecialty clinics such as Cardiology, Respiratory Medicine, Nephrology, Neurology, Endocrine and Diabetology, Haematology, Gastroenterology and Hepatology, Geriatrics and Rehabilitation Medicine.

In 2006, there were almost 6 million specialist outpatient attendances and about 1.9 million allied health outpatient attendances in public hospitals. To manage the high patient demand, the specialist clinics in public hospitals have implemented a triage system for screening new referrals so that patients requiring more urgent medical attention will be given earlier clinic appointments. Patients with priority I and II medical conditions would be seen within two weeks and eight weeks respectively. The triage criteria have been communicated to private practitioners to facilitate preliminary investigation of patients. The specialist clinics in many public hospitals have also worked with the family medicine specialist clinics within the same cluster to assess preliminarily patients with stable and low-risk medical conditions so as to shorten the waiting time for new referrals. Patients with stable conditions would either be referred back to the primary care practitioners in the private sector or the step-down clinics (general out-patient clinics) of the Hospital Authority for further follow-up and treatment.

In-patient services are offered to patients who require intense therapy for their acute illness. In the financial year 2005-06, about $16.8 billion were allocated for the provision of such services. These services are available in 15 major acute hospitals under the Hospital Authority. Supported by full ancillary services, clinicians in public hospitals are able to effectively treat patients with different medical needs through a comprehensive range of clinical specialties, including Internal Medicine, Surgery, Neurosurgery, Clinical Oncology, Cardiology, Obstetrics and Gynaecology, Ophthalmology, Orthopaedics and Traumatology, Otorhinolaryngology, Paediatrics, Pathology, Psychiatry, Radiology, Anaesthesiology, Intensive Care and others.

In 2006, there were 1.1 million in-patient and day patient discharges in public hospitals. As mentioned above, in line with international trend, the Hospital Authority has started to shift the delivery of healthcare away from hospitals to settings that are nearer to the patient's home. This represents a paradigm shift in the provision of health service from a disease model to a holistic health model, and from focusing on episodic acute hospital care to adopting a life-course approach with an emphasis on preventive, curative and rehabilitative health care. As a result, despite rapid increase in service demand due to the ageing population, the number of patient days, bed occupancy rates and average length of stay in public hospitals remained relatively constant over the past few years.

There are 15 public hospitals under the Hospital Authority providing Accident and Emergency Services. Their missions are to provide a high standard of emergency care to those in need of acute treatment, to offer emergency life support to the critically ill, and to manage disasters that bring in massive casualties. In the financial year 2005-06, about $1.5 billion were allocated for the provision of such services.

In 2006, the Accident and Emergency Departments of public hospitals had about 2 million attendances by 1.2 million patients, or 5 558 attendances per day. Since April 1999, patients attending the Accident and Emergency Departments are classified into five different categories according to their medical conditions, namely, Critical (Category 1), Emergency (Category 2), Urgent (Category 3), Semi-urgent (Category 4), and Non-urgent (Category 5). The triage system has proven to be an effective means to ensure that patients with more urgent conditions are promptly attended to. In 2006, over 95 per cent categories 1 and 2 patients were seen within the pledged waiting time.

Medical charges of hospital services in Hong Kong are affordable to the public, with government subsidy for public sector services representing a high level of 97 per cent of costs for in-patient services and 91 per cent of costs for ambulatory services. Recipients of Comprehensive Social Security Assistance (CSSA) are exempted from payment of public medical charges. In addition, an enhanced medical fee waiver mechanism has been implemented to protect vulnerable groups other than CSSA recipients, including low-income patients, chronically ill patients and elderly patients with economic difficulties, against financial hardship arising from healthcare needs.

The statistics gathered in 2005 showed that the 12 private hospitals served about 17.1 per cent of the total hospital in-patients in Hong Kong. The specialty beds in these hospitals provide mostly medicine, obstetrics and gynaecology, and surgery services.

Projects in the hospital development programme progressed satisfactorily. Ongoing projects included the redevelopment and expansion of Pok Oi Hospital, the redevelopment of Staff Quarters at Tuen Mun Hospital into a Rehabilitation Block, the construction of a new infectious disease centre attached to Princess Margaret Hospital, the provision of additional lifts and associated works at Block S of United Christian Hospital, the improvement of infection control provision for autopsy facilities in public hospitals, and the improvement of facilities in the Specialist Out-patient Block of Pamela Youde Nethersole Eastern Hospital.