8th ASHK Appointed Actuaries Symposium Healthcare, Financing and Insurance
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1 8th ASHK Appointed Actuaries Symposium Healthcare, Financing and Insurance Presentation by Thomas Chan Deputy Secretary, Food and Health Bureau 4 November 2008
2 Rapidly Ageing Population In out of 8 persons was an elderly person. By out of 4 persons will be an elderly person. Population profile in 2008 & 2036 Age group Male In 2008 Female Age group Male By 2036 Female Thousands Thousands Source: Hong Kong Population Estimates Mid-2008, C&SD Hong Kong Population Projections , C&SD
3 Population ('000) Rapidly Ageing Population Projection of total population, elderly population and elderly dependency ratio, Elderly Dependncy Ratio (No. of persons aged 65 and above per 1000 persons aged between 15 and 64) or above Elderly Dependency Ratio Source: Hong Kong Population Estimates Mid-2008, C&SD Hong Kong Population Projections , C&SD
4 Rapidly Ageing Population 600 Elderly dependency ratio, Number of elderly aged 65+ per 1000 population aged Actual Japan United Kingdom Switzerland Hong Kong Singapore Projection Australia Canada Hong Kong Japan Singapore Switzerland United Kingdom United States Source: Hong Kong Population Projections , C&SD; OECD Health Data 2008 (Jun 2008); Australian Bureau of Statistics; Statistics Canada; National Institute of Population and Social Security Research, Japan; U.S. Census Bureau, International Data Base; Government Actuary's Department, UK; U.S. Census Bureau; Statistics Finland
5 Rapidly Ageing Population The elderly population has greater healthcare needs The elderly population uses on average six times more in-patient care than the population aged below 65. Average no. of bed days per 1,000 persons 12,000 10,000 8,000 6,000 4,000 2,000 Average number of public hospital bed days utilized by age (2007) Age group Source: Data from Hospital Authority
6 Per capita health expenditure as % of per capita GDP Rising Medical Expenditure Per capita total expenditure as percentage of per capita GDP in HK and selected economies ( ) USA 12 Switzerland 10 Australia 8 Japan UK 6 Hong Kong 4 Singapore Source: OECD Health Data 2008 (Jun 2008); WHO NHA Series; Singapore Ministry of Health; HKDHA:
7 Average annual growth rate 8% 7% 6% 5% 4% 3% 2% 1% 0% Rising Medical Expenditure Medical Inflation - advance in medical technology, higher public expectation, rising medical cost -> medical inflation is driving increase in health expenditure everywhere Average annual real growth rate of total health expenditure and real growth rate of GDP in HKG and selected economies ( ) Average annual real growth rate of GDP Average annual real growth rate of total health expenditure Japan Switzerland UK USA HKG Australia Singapore Source: OECD Health Data 2008 (Jun 2008); WHO NHA Series; Singapore Ministry of Health; Statistics Singapore; HKDHA:
8 Source: Hong Kong s Domestic Health Accounts: Financial projection of Hong Kong s total expenditure on health from 2004 to 2033 Rising Medical Expenditure 10% Health expenditure as % of GDP % Health expenditure as % of GDP 8% 7% 6% 5% 4% 3% 2% 1% Past Health expenditure in HK in Projection Health expenditure in HK in Total health expenditure Public health expenditure Private health expenditure 0%
9 Economies HK Australia Canada Finland UK Austria Belgium Japan Korea Netherlands Switzerland US Singapore Comparison of public health expenditure and public spending in different economies Total health exp as % of GDP Public health exp as % of GDP Public exp as % of GDP Highest personal income tax 15.0% 45.0% 46.4% 49.3% 40.0% 42.7% 45.1% 47.2% 35.5% 52.0% 37.8% 41.3% 20.0% Sales tax - 10% 6-16% 22% 17.5% 20% 21% 5% 10% 19% 7.6% % 7% Public health exp as % of public exp Source: OECD Health Data 2008 (Jun 2008); WHO NHA Series; HKDHA: 1989/ /05; Inland Revenue Authority of Singapore; Federation of Tax Administrators; Inland Revenue Department, HK; Wikipedia.
10 Comparison of source of healthcare financing Economies HK Australia Canada Finland UK Austria Belgium Japan Korea Netherlands Switzerland US Singapore General taxation 54.8% 67.0% 69.3% 61.1% 87.4% 31.5% 4.6% 17.4% 12.5% 4.0% 17.2% 32.7% 27.9% Public Social health insurance % 14.9% % 66.6% 64.8% 42.6% 77.7% 43.0% 13.1% 5.8% Source of financing Private health insurance 12.4% 7.4% 12.5% 2.2% 1.0% 4.7% 5.4% 2.5% 3.3% 5.9% 8.5% 36.0% 1.9% Private Note: All figures are in 2006, except figures for Australia and Canada are in 2005 and 2007 respectively. Out-of-pocket payments/ other sources 32.7% 25.6% 16.8% 21.8% 11.6% 19.1% 23.5% 15.2% 41.6% 12.4% 31.2% 18.2% 64.5% Source: OECD Health Data 2008 (June 2008); WHO NHA Series; HK DHA 1989/ /05.
11 Per Capita TEH (US$ PPP) (log scale) 10,000 1,000 Hong Kong has spent relatively less on health compared to OECD countries 10, ,000 Per Capita GDP (US$ PPP) (log scale) 2004 Source: OECD Health Data 2008, June 2008 Hong Kong s Domestic Health Accounts: 2004/05 Australia Austria Belgium Canada Czech Republic Denmark Finland France Germany Greece Hungary Iceland Ireland Italy Japan Korea Luxembourg Mexico Netherlands New Zealand Norway Poland Portugal Slovak Republic Spain Sweden Switzerland Turkey United Kingdom United States Hong Kong SAR, China
12 Share of public expenditure on health (%) although public spending is commensurate with the different levels of public revenue between countries Public revenue as a % of GDP Source: OECD Health Data 2008, June Hong Kong s Domestic Health Accounts: 2004/05 Australia Austria Canada Czech Republic Finland France Germany Greece Hungary Ireland Italy Japan Korea Luxembourg Mexico New Zealand Norway Poland Portugal Slovak Republic Spain Sweden Switzerland United Kingdom United States Hong Kong SAR, China
13 Service Reform Healthcare Reform Hospital Care? Primary + Hospital Care Market Reform Public Provision? Public + Private Provision Financing Reform Tax-funded? Tax-funded +
14 Healthcare System Present Public Secondary/ tertiary healthcare Primary healthcare AED Public hospital (inpatient, SOPD) 29.1b subsidize 95% GOPC 4.5b subsidize 93% 4.Insufficient protection in safety net 2.Bottlenecks in public service 1.Primary health care not comprehensive enough 5.Lack of sharing of medical record 3.Publicprivate imbalance Private hospital 4.9b Private sector (general/specialist outpatient) 12.6b Private Public Source: Hong Kong s Domestic Health Accounts: 2004/05
15 Healthcare System Future Money follows patient Service benchmarking Secondary/ tertiary healthcare AED Public hospital (acute & emergency, underprivileged, catastrophic, training) PPP/ subsidize Private hospital Electronic Health Record System SOPC (Public) PPP/ subsidize SOPC (Private) Primary and community healthcare Public primary care (underprivileged, preventive care) PPP/ subsidize Private primary care (family doctors, dentists, TCM, allied health, community care) Subsidize preventive care
16 Healthcare Financing Present Public healthcare (mainly inpatient and specialist outpatient) 29.1b secondary/tertiary 4.5b primary Private healthcare (mainly outpatient) 4.9b hospital 12.6 b primary Government funding 31.9b Govt budget Tax Public fees 1.7b User pay Public Out-ofpocket 11.4b Private insurance Employer provided insurance Premium [x]b Insurance 6.1b Source: Hong Kong s Domestic Health Accounts: 2004/05
17 Healthcare Financing Future??? Money follows patient Service benchmarking Public healthcare PPP/ subsidize Private healthcare Increase govt funding Increase public fees Co-pay Increase insurance Govt budget SHI MSA Private insurance Employer provided insurance Increase tax Public
18 Financing what do we need? Save for future healthcare Subsidize the poor & underprivileged Share out the healthcare risk Support service and market reform
19 Insurance does it fit the bill? Yes Risk-pooling/sharing Subsidize the sick Purchaser role Choice of service Money follows patient? No No saving in general No wealth re-distribution Risk-pooling at what cost? Moral hazards Lack continuity & certainty
20 The Health Insurance Triangle Insurers anti -selection risk selection premium hike moral hazards cost control autonomy Patients demand supply Providers
21 Where can we meet? Voluntary Group/Individual Small risk pots Underwriting Itemized charging Unsubsidized Self-regulated Mandatory Portability/Continuity Large risk pool Age-banded/ Community-rated Case-mix pricing Incentivized Regulated
22 Can insurance do better? Less exclusions Premium guarantee Renewal guarantee Better continuity/portability Provision for future Incentives to stay on Price transparency Health-outcome-oriented Utilization/cost-control
23 What the industry needs? A level-playing field Incentives Product features comparison? E-Platform? Cost/utilization benchmarking? Collective bargaining? Re-insurance or shared-pool? Consumer buy-in
24 Thank You
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