Challenges Ahead in Healthcare Management

HA Convention

16 May 2013

1

Dr S V Lo Director (Strategy & Planning)

Hospital Authority

Population Ageing: Challenges to the Hospital Authority

2

Population Ageing in Hong Kong

3 Source: Census & Statistics Department, HKSAR

TFR

70

75

80

85

90

95

100

105

110

0

500

1000

1500

2000

1981 1986 1991 1996 2001 2006 2011 2016 2021 2026 2031

Total Fertility Rate (TFR) (No. of live births per 1,000 women)

Life Expectancy (LE) (Years)

TFR

Male LE

Female LE

70

75

80

85

90

95

100

105

110

0

500

1000

1500

2000

1981 1986 1991 1996 2001 2006 2011 2016 2021 2026 2031

Total Fertility Rate (TFR) (No. of live births per 1,000 women)

Life Expectancy (LE) (Years)

Proportion of Young Children in Hong Kong is Declining While Proportion of Elderly Increases Significantly

Age <5

Age 65+

0%

5%

10%

15%

20%

25%

30%

1981 1986 1991 1996 2001 2006 2011 2016 2021 2026 2031

Source: Census & Statistics Department, HKSAR 4

% o

f H

on

g K

on

g Po

pu

lati

on

Speed of Population Ageing

5

Time required/expected for the proportion of elderly population to rise from 7% to 14%

Source: Kinsella K, He W. An Aging World: 2008. Washington, DC: National Institute on Aging and U.S. Census Bureau 2009.

Hong Kong Figures from Census & Statistics Department, HKSAR

Per

cent

age

of P

opul

atio

n A

ged

65+

7%

14%

1860 1880 1900 1920 1940 1960 1980 2000 2020 2040

5

10

15

20

25

30

35

HK China Japan France US UK Sweden

Hong Kong Elderly Population is Growing at a Faster Rate

6

Pro

po

rtio

n o

f P

op

ula

tio

n A

ged

65

+ (%

)

9%

5% 6%

12%

2012 2031

Source: OECD Factbook 2013: Economic, Environmental and Social Statistics; Hong Kong Population Projections 2010-2039, Census & Statistics Department, HKSAR

8%

6%

4%

2012 2031 2012 2031 2012 2031 2012 2031 2012 2031 2012 2031

Hong Kong Population Pyramid

7

Male Female

500 400 300 200 100 0 100 200 300 400 500

00-04

05-09

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+

Male Female

500 400 300 200 100 0 100 200 300 400 500

00-04

05-09

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+

Male Female

500 400 300 200 100 0 100 200 300 400 500

00-04

05-09

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+

1991 2012 2031

Source: Demographic Statistics Section, Census & Statistics Department, HKSAR Hong Kong Population Projections 2010-2039, Census & Statistics Department, HKSAR Remarks: The figures for 1991 are compiled based on the "extended de facto" method.

Thousands Thousands Thousands

Age 85 +107 900

(8%)

Hong Kong Demographic Change, 2012 to 2031

6.21M 6.28M

0.97M 2.18M

2012 2031

Age 7.18M 8.46M

65

0-64 Age 0-64 +75 100

(6%)

Age 65 +1 205 100

(94%)

Population Increase

All: 1 280 200

Projected Population

Source: Hong Kong Population Projections 2010-2039, Census & Statistics Department, HKSAR

Elderly people will increase by 124% while overall population by 18%

Age 65-84 +1 097 200

(86%)

8

Elders and Disease Patterns

9

Institution Elderly in Hong Kong who had Chronic Diseases

Source : Thematic Household Survey No. 40, Census & Statistics Department, HKSAR, 2009

Selected type of chronic diseases

No. of persons ('000)

%

Hypertension 33.5 59

Stroke 18.2 32

Alzheimer Disease / Dementia 17.9 32

Eye diseases 14.2 25

Diabetes 13.2 23

Heart diseases 12.9 23

Arthritis 9.8 17

Fractures 7.2 13

Respiratory diseases 4.9 9

Gastric diseases 4.5 8

Depression 4.4 8

Cancer (including all body parts) 3.5 6

Osteoporosis 3.3 6

Diseases of the ear / nose / throat (ENT)

2.9 5

Overall 56.6

Dementia - Overseas Experience

10

1.6 2.9

7.2

15.5

23.5

29.9

1.3

3.6

7.7

15.1

28.4

42.2

0

5

10

15

20

25

30

35

40

45

65 - 69 70- 74 75 - 79 80 - 84 85 - 89 90+

Pre

vale

nce

pe

r 1

00

pe

rso

ns

Age group

Prevalence of dementia per 100 persons by age and sex in United States

Males

Females

Source: OECD Health Working Paper 13 (2004) Dementia Care in 9 OECD Countries: A Comparative Analysis

Hospital Authority (HA)

11

Government policy: No one should be denied adequate medical treatment through lack of means Provides public healthcare services to 7 Million Hong Kong residents An average 80,000 patients per day receiving services from HA

12

Mass rally on 1 July 2012

Information from Police: 63,000 people

Challenges

1. Increasing Service Volume

2. Developing responsive service models

3. Nurturing Skilled Workforce

4. Optimising the use of Modern Technologies

5. Maintaining a Financially Sustainable Organization

13

Increasing Service Volume

14 Remarks: HA Service Statistics, 2008/09 - 2012/13

7.3

7.4

7.5

7.6

7.7

7.8

7.9

2008/09 2009/10 2010/11 2011/12 2012/13

Pat

ien

t d

ays

(in

mill

ion

)

Inpatient / Day Patient

2.1

2.2

2.3

2008/09 2009/10 2010/11 2011/12 2012/13

Tota

l att

end

ance

s (i

n m

illio

n)

Accident & Emergency

0.30

0.35

0.40

0.45

2008/09 2009/10 2010/11 2011/12 2012/13

Op

erat

ion

s (i

n m

illio

n)

Operations

6.0

6.2

6.4

6.6

6.8

7.0

2008/09 2009/10 2010/11 2011/12 2012/13

Tota

l att

end

ance

s (i

n m

illio

n)

Specialist Outpatient

+410 ,000 patient days

(+6%)

+140,000 attendances

(+6%)

+810,000 attendances

(+13%)

+100,000 operations

(+28%)

Elderly’s Share in HA Service Throughput

15

Patient activities (in million)

Services* All Age Aged 65+ % of Elderly’s

Share

Inpatient / Day Patient 7.7 3.8 49%

Accident & Emergency 2.2 0.6 27%

Specialist Outpatient 6.7 2.2 33%

Primary Care 5.6 2.1 38%

Allied Health Outpatient

2.2 0.5 22%

Day Rehabilitation Services

0.5 0.2 46%

Remarks * HA Service Statistics, 2011/12; Patients with missing age were excluded.

Impact of Population Ageing: Service Utilization

16

0

2,000

4,000

6,000

8,000

10,000

0 01 - 04 05 - 09 10 - 14 15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84 85+

Age Group

2005

2010

*

Inpatient Service Utilization (Age-specific) Patient days# per 1,000 population

Remarks # Patient days for General Specialty only (i.e. Care Category: Acute General or Convalescence/Rehabilitation). * Figures at age 0 refer to patient days (exclude Nursery only) per 1000 registered births.

Impact of Population Ageing: Hospital Admission

17

Non-Elderly (< 65) Elderly (65+)

1 vs. 4

Ever admitted to any HA hospital (General specialty*)

2.6 in 10 0.7 in 10

Remarks * Refers to Acute General and Convalescence/Rehabilitation in 2010. Age 0 are excluded in the calculation of hospital services utilization.

Hospitalization rate of elderly people is 4 times that of non-elderly

Impact of Population Ageing: Hospital Bed Requirement

18

Per 1,000 Non-Elderly (<65) Per 1,000 Elderly (65+)

Hospital Bed Requirement*

(General specialty)

1.3 beds 11.8 beds

1 vs. 9 Remarks * Bed requirement is based on the rate of patient days per population for General Specialty only (i.e. Acute General and Convalescence/Rehabilitation) in 2010. Age 0 are excluded in the calculation of hospital services utilization.

Elderly population’s requirement for hospital beds is 9 times of non-elderly’s

Demographic Change & Hospital Beds Requirement 2012 to 2031

6.21M 6.28M

0.97M 2.18M

2012 2031

Age 7.18M 8.46M

65

0-64

Additional Hospital Beds

Require: 9,200 beds

Projected Population

Source: Hong Kong Population Projections 2010-2039, Census & Statistics Department, HKSAR 19

New Territories: 61% Kowloon: 29% Hong Kong: 10%

Prepare to expand capacity Build new hospitals

Expand / redevelop existing hospitals

20

Elder Friendly Design

21

What can the built hospital environment do to maximize the functional ability of the elderly?

• Bigger waiting areas – Space for wheelchairs

– Range of seat type to suit different patients

– Reduce trip hazards

• Space to move independently with/without mobility aids

Challenges

1. Increasing Service Volume

2. Developing responsive service models

3. Nurturing Skilled Workforce

4. Optimising the use of Modern Technologies

5. Maintaining a Financially Sustainable Organization

22

Service delivery Models

• Changing patterns of diseases

• Increasing disease complexity

• Diverse needs of patients

23

Require service delivery models that are responsive to patients

System Perspective

• Separate large volume of elective procedures from emergency

• Develop large independently functioning ambulatory centres – Diagnostic imaging

– Pathology investigations

– Therapeutic & intervetional procedures

24

Incorporating Innovations into Service Models

25

• Community Health Call Centre

– Proactive outbound calls

– Provide support to post-discharged high risk elderly patients: drugs, symptoms, fast track access

– Empower and reinforce self-management behaviours of chronic patients

• Remote patient monitoring e.g. diabetes, hypertension

Achieve better coordination of care

Across different levels of healthcare

Across health and social sectors

Facilitate integration, avoid fragmentation

26

Challenges

1. Increasing Service Volume

2. Developing Responsive Service Models

3. Nurturing Skilled Workforce

4. Optimising the use of Modern Technologies

5. Maintaining a sustainable organization

27

Additional Health Workforce Required

The provision of 9,200 new beds will require additional manpower:

28

But HA is facing considerable manpower challenges

2031 vs 2012

Additional Doctors ~ 2,800

Additional Nurses ~ 10,000

Additional Allied Health professionals

~3,500

Adequate Number

• Reduce attrition

– Improve career prospects

– Enhance training opportunities

– Improve work environment

– Implement flexible employment

• Ensure adequate supply

– Local production: lead time required

– Overseas graduates: need to overcome local difficulties

– Make better use of retired staff

29

Appropriate Skillsets

• Holistic approach

• Geriactric skillsets

• Multi-sectoral, inter-dsiciplinary team working

30

Build a modern workforce that is appropriately skilled

Challenges

1. Increasing Service Volume

2. Developing Innovative Service Models

3. Nurturing Skilled Workforce

4. Optimising the use of Modern Technologies

5. Maintaining a sustainable organization

31

New Techologies

• Rapid advances in medical science

• Shape & influence the practice of medicine

• Regenerative medicine

– Addressing degenerative diseases associated with ageing

– Technology that could replace the long-term management of chronic diseases with cures for many major conditions

– Stem cell transplantation, cell reprogramming, synthetic organ creation

32

Robots

33

RP-VITA (US) Approved by FDA. Telemedicine consults inclusive of active patient monitoring in high-acuity environments where immediate clinical action may be required

Actroid-F (Japan) Provide patients with companionship during their hospital stays

RIBA (Japan) Assist nurses by lifting patients in and out of their beds and wheelchairs

KIRO-M5 (Korea) Alerts residents to scheduled activities and emergencies, detects soiled diapers and can function as a walker

Assistive Technology A device or system that allows individuals to perform tasks they would otherwise be unable to do, or increases the ease and safety with which tasks can be performed (WHO, 2004)

Common conditions affecting people over age 65

Assistive technology that can help to alleviate the condition and maintain independence

Arthritis Equipment for daily living

Hypertension and heart disease Telehealth for remote monitoring of vital signs such as heart rate and variability and body weight

Diabetes Orthopaedic footwear; telehealth for remote monitoring of blood glucose, hypoglycaemia alarms and medication reminders

Hearing problems Hearing aids, induction loops, text phones

Cataracts and other forms of visual degeneration

Visual aids, better lighting, reading magnification cameras and displays, colour sensors, text to sound converters

Mobility problems Wheelchairs, walking-frames, stair-lifts, fall detectors, bed monitors, personal environmental controls

Dementia Telecare systems to monitor safety and movement 35

Judiciously manage the entry of new and expensive technologies

36

Challenges

1. Increasing Service Volume

2. Developing Innovative Service Models

3. Nurturing Skilled Workforce

4. Optimising the use of Modern Technologies

5. Maintaining a sustainable organization

37

Modern Healthcare is Expensive

38 Source: Health Care Cost Institute. 2010 Health Care Cost and Utilization Report

Healthcare Expenditure: International Comparison

39

Australia

Canada Germany

Hong Kong

Japan

Korea

United Kingdom

United States

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

19

60

19

62

19

64

19

66

19

68

19

70

19

72

19

74

19

76

19

78

19

80

19

82

19

84

19

86

19

88

19

90

19

92

19

94

19

96

19

98

20

00

20

02

20

04

20

06

20

08

20

10

Tota

l exp

en

dit

ure

on

he

alth

, % G

DP

Source: OECD Health Data 2012 Hong Kong’s Domestic Health Accounts - Estimate of Domestic Health Expenditure, 1989/90 – 2009/10

Achieve financial sustainability

40

To meet the challenges of population ageing, we also need…

41

Long Term Care to be

better developed

42

and

More Research on the impact of population ageing and effective ways to

address the issues

Thank You!

43