Healthcare Reform: Ageing Demographics & Medical Inflation

1. Healthcare Service Reform Initiative e-Health Record Sharing System :Vision, Actions, Lessons and Prognosis

2. Healthcare Reform: Ageing Demographics & Medical Inflation

3. Mid 2039 Mid 2009 Male Female Female Male Hong Kong population will be ageing rapidly Population profile in 2009 & 2039 In 2009 – 1 out of 8 persons was an elderly person. By 2039 – 1 out of 4 persons will be an elderly person. Source: Hong Kong Population Projections 2009 -2039, C&SD

4. Hong Kong will see one of the fastest ageing among advanced economies Elderly Dependency Ratio of Hong Kong and Selected Economies

5. 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. Source: Data from Hospital Authority

6. Everywhere health expenditure is growing faster than the economy Average annual real growth rate of total health expenditure and real growth rate of GDP in HKG and selected economies (1995-2004) Source: OECD Health Data 2008 (Jun 2008); WHO – NHA Series; Singapore Ministry of Health; Statistics Singapore; HKDHA: 1990-2004. Medical Inflation - advance in medical technology, higher public expectation, rising medical cost -> medical inflation is driving increase in health expenditure everywhere

7. Hong Kong’s health expenditure projected to rise as a share of the economy Health expenditure as % of GDP 1990 - 2033 9.2% 5.3% 5.5% 2.9% Source: Hong Kong’s Domestic Health Accounts: 1990 - 2004 Financial projection of Hong Kong’s total expenditure on health from 2004 to 2033 2004 to 2033: Ageing + Medical Inflation Per capita health expenditure nearly quadruple when per capita GDP will only double

8. Problems in the Existing Healthcare System • Primary healthcare service not comprehensive enough • Bottlenecks exist in public healthcare service and long waiting time • Public-private imbalance in healthcare system and limited choices for patients • Insufficient protection provided under the current public healthcare safety net • Lack of sharing of medical records between doctors in public and private hospitals

9. Healthcare Reform: Enhancing Services on a Sustainable Basis

10. First Stage: Healthcare Service Reform • Enhance primary care • Primary Care Development Strategy by end 2010 • Promote public-private partnership in healthcare • PPP projects being launched progressively • Develop electronic health record sharing • First stage eHR Programme for sharing by 2013-14 • Strengthen public healthcare safety net • Expand Drug Formulary to support patients in need • Over $5 billion committed for service reform

11. (1) Enhance Primary care To put greater emphasis on preventive care, promote healthy lifestyle, improve the state of health of people, reduce the need for hospital care. • Develop basic models for primary care services • Establish a family doctor register • Subsidize individuals for preventive care • Improve public primary care • Strengthen the function of the Department of Health in health education

12. (2) Promote Public-Private Partnership in Healthcare Provide the public with more choices of quality healthcare services and promote healthy competition and collaboration among the public and private sectors • Purchase primary care from the private market • Subsidize individuals to undertake preventive care in the private sector • Purchase hospital services from the private market • Pursue hospital development under the PPP model • Set up multi-partite medical centres of excellence • Engage private sector doctors to practise in public hospitals on a part-time basis

13. (3) Develop Electronic Health Record Sharing As an infrastructure, electronic health record sharing can effectively enhance continuity of care, facilitate better integration of different healthcare services, and minimise duplicate investigations • Fund the development of the sharing infrastructure • Make available the know-how to the private sector • Consider provision of financial assistance • Promote the benefits of health recordsharing to patients and healthcareprofessionals

14. (4) Strengthen Public Healthcare Safety Net To provide better healthcare protection for patients who need to use public healthcare services • Reduce waiting time of public hospital services • Improve the coverage of standard public services • Explore the idea of a personal limit on medical expenses • Inject funding into the Samaritan Fund

15. Healthcare Reform: Enhancing Services on a Sustainable Basis • First Stage Consultation (2008): Healthcare Service and Financing Reform • The public support reform in general, but have reservations about mandatory supplementary financing • Prefer voluntary private health insurance, and choice of private healthcare services according to one’s needs • Want more choice and better protection beyond public healthcare services provided by the Government • Second Stage Consultation (2010): Voluntary Health Protection Scheme (HPS) • Standardise and regulate voluntary private health insurance by legislation for consumer protection • Formulate HPScore requirements and specifications to address shortcomings of existing private health insurance • Consider making use $50 billion fiscal reserve to provide subsidies to HPS subscribers

16. Public Healthcare: Unswerving Government Commitment • The Government will only increase, and not reduce, its commitment to healthcare • Government continues to increase funding for healthcare • Funding for healthcare increases from $30.5 billion in 2007-08 to $36.9 billion in 2010-11, up from 15% to 16% of the Government’s total recurrent expenditure • Subvention for Hospital Authority (HA) increases from $28.0 billion in 2007-08 to $32.7 billion in 2010-11, and will be further increased in 2011-12 • Government committed over $15 billion to invest in healthcare infrastructure and strengthen safety net, including $1 billion injection into the Samaritan Fund

17. Public Healthcare: Unswerving Government Commitment • Uphold public healthcare system as the community’s healthcare safety net • Public healthcare system will continue to focus on target service areas • Acute and emergency care • Care for low-income and under-privileged groups • Catastrophic illness requiring professional team work, advanced technology and high cost • Training of healthcare professionals • HA making use of increased funding to reinforce manpower and enhance various public healthcare services

18. Hong Kong Territory-wide Electronic Health Record Sharing System www.ehealth.gov.hk

19. Objectives • Develop a territory-wide patient oriented electronic health record (eHR) sharing system • Enhance the continuity of care and better integration of different healthcare services

20. What is eHR? • NOT just an IT project • A territory-wide “infrastructure” • Key to improve our health service delivery system in future • Indispensable component for our future health care reform & financing arrangements • Benefits everyone: 1 person’s record, multiple access – patients, medical professional, health care workers etc • Change the way health care is provided: faster, efficient, accurate • Essential data source for disease surveillance • AMBITIOUS project – no country-wide EHR in the world yet

21. Hospital Authority 8 million patient records 800 million lab results 340 million prescribed drugrecords 34 million X-ray images 3 million transactions perday Private Hospitals Mainly electronic billing and financial systems Electronic record lacks sharing capability Present Situation • Private Clinics • Mostly paper-based records • Electronic record lacks sharing capability • Department of Health • Essential health data, e.g. vaccination • Preparing for eHR sharing • Private Labs/ • Allied Health Providers • Not connected to other providers

22. Dentists Private Hospital HA X-ray DH Without eHR Doctors Nurses

23. With eHR

24. Hospital Authority Private Hospitals Benefits of eHR Sharing For Patients Whole record available online Timely and accurate information for care Increase the speed of treatment For Healthcare Providers Efficient clinical practice Avoid errors associated with paper records For Society Disease surveillance Public health and policy making

25. Challenges • Privacy and security concerns, eHR legal framework • Change management • Project management and institutional framework • Standarisation • Building block approach – pilots • Public private partnership • eHR Engagement Initiatives • Partnership project • CMS extension and CMS adaptation

26. Guiding Principles • Government-led model for development • Compelling but not compulsory record sharing • Data privacy and system security of paramount importance • Open technical standards for private participation • Building-block approach for eHR components

27. eHR Legal Framework • The privacy and security challenges of eHR • An eHR specific legislation • Consultant to review the Framework for eHR • Privacy Impact Assessment

28. Public-PrivateInterface Projects eHR PMO HA IT Services Private Projects eHR Projects Hospital Authority (HA) Government Private sector eHR Office Steering Committee on eHR Sharing Working Group on Institutional Arrangement Working Group on Legal, Privacy and Security Issues Working Group on eHR and Information Standard Working Group on eHR Partnership Project Management and Institutional Framework

29. Standardisation of Health Record • Define a scope of eHR sharable data • Standardise Patient Master Index, immunisation record, drug record, etc. • Support promotion of HL7, ICPC, SNOMED CT, etc.

30. Public Private Partnership • eHR Engagement Initiative • 1st Stage EEI for Private Healthcare Sector (Oct 2009) • 2nd Stage EEI for IT sector (Nov 2010) • Partnership Projects • eHealth Consortium – Validation Platform • HK Medical Association - CMS 3.0 • HK Dental Association – Dental Clinic Management System

31. Budget and Targets • HK$702 million for first stage Total budget : HK$1.1 billion • To have the eHR sharing platform ready by 2013-14 for connection with all public and private hospitals • To make available electronic medical/patient record (eMR/ePR) systems with eHR sharing capability • Legal framework

32. Major Milestones

33. Thank You