Barriers to preventive care utilization among Hong Kong community‐dwelling older people and their views on using financial incentives to improve preventive care utilization

BackgroundFinancial incentive is increasingly used as a mean to promote preventive care utilization (PCU), but the current Elderly Health Care Voucher Scheme (EHCVS) in Hong Kong is ineffective for encouraging PCU.ObjectiveTo explore the older people''s barriers to PCU and their views on financial incentive, including EHCVS, for improving private PCU.Design and settingFocus‐group discussions were conducted in community elderly centres located in five districts of Hong Kong.ParticipantsCommunity‐dwelling older people aged 60 years or above.ResultsLack of understanding about preventive care and low awareness of the need for preventive care were key factors for the low motivation for PCU. Uncertainty over the level of service fee charged and concerns over service quality hindered the choice of using the private service providers under the current EHCVS. Financial incentives specific for preventive care services were thought to be cues to actions and guides for service promotion. However, some flexibility in service coverage and a set time limit of the financial incentives were preferred to accommodate individual needs.ConclusionsApart from promoting knowledge of preventive care, official monitoring for service fee and quality is important for empowering older people to choose private service providers for preventive care. Financial incentives for preventive care services should be more specific to cue service promotion and uptake of preventive care while maintaining flexibility to accommodate individual needs.Patient or public contributionParticipants were recruited using purposive sampling with the coordination of community elderly centres. Data were analysed using thematic coding.     

Factors associated with the use of publicly funded services by Hong Kong Chinese older adults

This article analyzes cross-sectional data collected from a representative community sample of 2003 Chinese elderly people aged 60 or above in Hong Kong. We examined whether the use of publicly funded health services by older adults is equitable under the framework of Andersen model. A number of predisposing, enabling, and need factors were assessed as predictors of utilization in four categories of services including hospital admission, emergency room, general outpatient clinics, and specialist outpatient clinics. It was found that utilization of these four health services was consistently correlated with need factors. Specifically, self-rated health status and particular types of chronic illness were consistently and significantly related to utilization for all four of services in Hong Kong. On the other hand, age and family support were related to hospital admission whereas functional impairment was associated with the use of emergency room and general outpatient clinics. Findings suggest that publicly funded health services in Hong Kong are used equitably by elderly people.     

Determinants of job satisfaction in foreign domestic helpers caring for people with dementia in Hong Kong

The job satisfaction of live‐in foreign domestic helpers (FDHs) may influence their caring motivation and the quality of care they provide, which may in turn affect the health status of care recipients. This study identifies the factors affecting job satisfaction of FDHs caring for people with dementia in Hong Kong, focusing especially on the role of FDHs' adaptation status, job self‐efficacy and care recipients' situation. A total of 152 FDHs taking care of people with dementia were recruited from 6 day care centres for elderly people in Hong Kong when they attended with their care recipients. Data were collected from February to August 2011 and the response rate was 95%. Participants completed questionnaires which included measures of care recipients' dementia severity and disruptive behaviours, FDHs' demographic factors, personal adaptation status, caregiving self‐efficacy and job satisfaction. Hierarchical regression analysis was conducted to analyse the data. The results showed that longer stay in Hong Kong, better fluency in Cantonese (local dialect), greater satisfaction in living conditions, higher caregiving self‐efficacy and less disruptive behaviour of care recipients were independently associated with stronger job satisfaction in FDHs looking after people with dementia. On the basis of these findings, we would suggest that employers should consider helpers who have been in Hong Kong for a longer period of time and speak fluent Cantonese, and have previous experience of taking care of people with dementia. In addition, FDHs caring for people with dementia may benefit from carer training which improves their self‐efficacy in dementia care.     

老龄化、临近死亡与医疗支出

目的:分析个体微观层面下年龄、临近死亡对医疗支出的影响。方法:利用2011年和2013年中国健康与养老追踪调查数据(CHARLS),通过构建两步估计模型分析临近死亡对医疗支出的影响。结果:当临近死亡时,伴随着年龄的增长医疗支出会出现先增长然后下降的趋势,即实际死亡年龄越高,其平均医疗费用支出反而越低。结论:临近死亡因素是影响医疗支出的显著因素,临近死亡时医疗支会出现显著的增加。具体到临近死亡时间,临近死亡1年和临近死亡两年对医疗支出的影响显著,临近死亡3年的影响不显著,而年龄对于医疗支出的影响不再显著。结论:老龄化背景下虽然由于老年人口比例的上升会给整个社会带来巨大的医疗支出负担,但不能简单的将老龄化与医疗支出上涨相联系,更不能过度夸大老龄化对医疗支出上涨的作用。     

Eliciting preferences for resource allocation in mental health care in Ireland

The proportion of total health care expenditure devoted to mental health care in Ireland, at just below 7%, is low relative to other countries. There have been few studies that have examined the relationship between public preferences for different kinds of health care expenditure and priority setting as undertaken by policy-makers and governments. This paper examines citizen's rankings and willingness to pay for a community-based mental health care programme in Ireland relative to two other programmes: cancer and elderly care. Respondents rank cancer as the most important programme, followed by elderly care and then mental health care. The contingent valuation survey demonstrated that people are willing to make significant tax contributions to new community-based services for people with mental health problems, counteracting the view sometimes expressed that people do not care at all about mental health care provision. However, the survey also found that people tend to value additional spending on mental health care lower than cancer and elderly care programmes.     

Eliciting preferences for resource allocation in mental health care in Ireland

The proportion of total health care expenditure devoted to mental health care in Ireland, at just below 7%, is low relative to other countries. There have been few studies that have examined the relationship between public preferences for different kinds of health care expenditure and priority setting as undertaken by policy-makers and governments. This paper examines citizen's rankings and willingness to pay for a community-based mental health care programme in Ireland relative to two other programmes: cancer and elderly care. Respondents rank cancer as the most important programme, followed by elderly care and then mental health care. The contingent valuation survey demonstrated that people are willing to make significant tax contributions to new community-based services for people with mental health problems, counteracting the view sometimes expressed that people do not care at all about mental health care provision. However, the survey also found that people tend to value additional spending on mental health care lower than cancer and elderly care programmes.     

The mental health status and long term care needs of the Chinese elderly in Hong Kong

This paper examines the mental health status of 945 Chinese older people who are in need of long term care services in Hong Kong. It was found that for those aged respondents who are already waiting for admission to infirmary, over 59.3% were already living in private aged homes, and only as few as 17.8% of these applicants were still living in their own homes. Besides, it was found that the mean SPMSQ score was lowest amongst those living in medical infirmary (1.52) and highest for those living in their own residences (5.99). Analysis of the relationship between GDS scores and residential types reveals that there were higher proportion of respondents residing in their own residences that fell into the highly depressed category. There is a need for the overall revamp of the planning, provision and financing for long term care and psychogeriatric services for Chinese older people in Hong Kong.     

Health care in Hong Kong and mainland China: one country, two systems?

Hong Kong and Mainland China are undertaking health reform following recent economic fluctuations and Hong Kong's transformation to a Special Administrative Region of China in 1997. Despite spending only 4.7% of its Gross Domestic Product on health care, one third as much as in the United States, Hong Kong has developed health statistics comparable to those in leading western nations. In contrast, Mainland China's 3.6% of GDP expenditure on health is associated with health statistics and expenditures similar to those found in most developing countries. Hong Kong has adopted health care financing and organizational health systems that are commonly seen in centrally planned economies, while its economy functions as a highly capitalistic enterprise. In contrast, mainland China has integrated many features of health care systems associated with market economies, while its overall economy is largely centrally planned. In this paper we examine the policy factors associated with these disparate health systems and investigate whether they can be maintained according to the 'one country, two systems' approach that has been adopted by Chinese policy makers.     

Older school children are not necessarily healthier: analysis of medical consultation pattern of school children from a territory-wide School Health Surveillance

It is important to maintain the health of our school children as health is a major factor affecting learning. In developed countries, we assume that school children, especially in higher grades, are healthy because they are relatively free of diseases. However, many of the health problems encountered by school children are not reported in routine health data as they seek help in primary care or by self-medication. In this paper, the medical consultation pattern of school children in Hong Kong was analyzed. It was revealed that school children had a high rate of consultation and self-medication, and the health status of older school children is not better. They were not offered adequate preventive advice. The piecemeal approach to focus on curative medicine will only lead to a high rate of episodic consultation and self-medication without empowering the young people with the skills of self-care and self-help, and positive health behavior. The concept of a health-promoting school with emphasis on more extra-curricular health promotion activities, improved communication between health and education sectors, active involvement by pupils and parents, and changing policies and practices would help to make the co-ordinated school health program a greater success.     

Consumers' perceptions of health care: the case of Hong Kong

The health care industry in Hong Kong has undergone major changes in organization as well as philosophy of operation since the 1970s. During this period, the Hong Kong government has also experienced a political transition from colonial status to a special administrative region of Mainland China. Because of the economic downturn in East Asia, including Hong Kong, contraction of public spending has compelled the government to reconsider the alternatives for health care provision in Hong Kong. A number of multinational health care providers have entered this market and operate mainly in the private sector, including solely-owned clinics and alliances with existing hospitals. This paper provides an understanding of the evolution and development of the health care industry in Hong Kong and, on that basis, suggests elements of quality health care from the findings of a survey of patients.     

Vouchers for primary healthcare services in an ageing world? The perspectives of elderly voucher recipients in Hong Kong

Considering the ageing population in economically advanced regions across the world, measures are necessary to enhance the health of the older population as well as contain public healthcare spending. Hong Kong implements the Elderly Health Care Voucher Scheme (EHCVS), providing older people aged 65 or above an annual subsidy of visiting private healthcare service providers for chronic disease prevention and management. The services also aim at reallocating demand from the public to private sector as well as improve quality of services. This qualitative study explored the experiences of EHCVS recipients (n = 55, aged 61–94) with eight focus group interviews in Hong Kong in the year 2016. Convenience sampling was used. Research questions were: (1) Why do older people choose not to use EHCVS for preventive as well as disease management services among older people in Hong Kong? (2) What are the barriers to reallocating demand from the public to private sector? (3) In what ways did EHCVS improve the quality of primary care services for older people? Using a deductive and inductive approach, eight qualitative themes were identified. Findings suggested that the non‐targeted services and inadequate knowledge on EHCVS deterred older people from using the vouchers for disease management and prevention. The relatively expensive private services, lack of trust in the private sector, low public clinic fees and good services quality of the public sector, together with inadequate private practitioners in the healthcare market were barriers that hinder demand reallocation. Nevertheless, the quality of primary care services had been improved after the implementation of EHCVS with shortened wait times and opportunities to discuss health‐related issues with private practitioners. Findings were discussed with practice, policy and research implications.     

The Mental Health Status and Long Term Care Needs of the Chinese Elderly in Hong Kong

ABSTRACT

This paper examines the mental health status of 945 Chinese older people who are in need of long term care services in Hong Kong. It was found that for those aged respondents who are already waiting for admission to infirmary, over 59.3% were already living in private aged homes, and only as few as 17.8% of these applicants were still living in their own homes. Besides, it was found that the mean SPMSQ score was lowest amongst those living in medical infirmary (1.52) and highest for those living in their own residences (5.99). Analysis of the relationship between GDS scores and residential types reveals that there were higher proportion of respondents residing in their own residences that fell into the highly depressed category. There is a need for the overall revamp of the planning, provision and financing for long term care and psychogeriatric services for Chinese older people in Hong Kong.     

Health promotion and older people: the role of the general practitioner in Australia in promoting healthy ageing

OBJECTIVE: The Commonwealth Government's Enhanced Primary Care initiative supports measures to enhance the role of general practitioners (GPs) in promoting healthy ageing as part of a population health approach. This paper comments on how the health assessments can be conducted to best effect, to strengthen the role of GPs in primary care and to promote autonomy and independence in older people. METHOD: The relevant literature was collated to produce a review of public health and health promotion approaches and to ascertain the effectiveness of health promotion interventions for older people. A broad definition of health promotion including primary, secondary and tertiary prevention was adopted. RESULTS: The evidence base suggests there is scope for greater targeting of health promotion activities towards older people. The rationale for the Australian GP to assume a major health promotion role with their older patients is provided. Associated barriers and enablers are discussed. CONCLUSIONS: Prevention of disability is a key public health issue. The new MBS items may enable systematic evaluation of function and assist healthy ageing for all older people, including the frail aged. An increase in the preventive advice given to older patients has the potential to increase healthy behaviours and alter health outcomes. IMPLICATIONS: The annual health assessment items on the Medicare Benefits Schedule, by enabling the GP to focus on prevention and coordination of care, have the potential to improve the health, physical, psychological and social function of older Australians.     

Age and marital status are major factors associated with institutionalisation in elderly Hong Kong Chinese.

STUDY OBJECTIVE--To determine the need for long term institutional care for elderly Chinese living in Hong Kong and factors associated with institutional living. DESIGN--Survey by interviewer administered questionnaire of a stratified random sample of all recipients of old age or disability allowance covering 90% of the population. SETTING--Survey performed in Hong Kong, a city on the south coast of China with an area of 1070 km2 and approximately six million people. PARTICIPANTS--A total of 2032 subjects aged 70 years and over (999 men, 1033 women) participated. MAIN RESULTS--Overall, 16% of the elderly live in institutions. The percentage is higher in women and in the older age group (81% for those aged 80 years and over). After adjusting for age and sex, the following factors were positively associated with institutionalisation: poor cognitive function, measures of functional disability, poor vision, Parkinson's disease, stroke, and past fractures. Multivariate analysis identified age and marital status as associated factors with the highest odds ratio (13.6 and 7.1 respectively), followed by various disability indicators. CONCLUSION--The survey shows that requirements for long term care places are unlikely to be much affected by preventive measures, and would need to increase by about 30% by 2000 to cope with the projected increase in the number of elderly aged 70 years and over. Measures to provide sufficient trained personnel and policy for regulation of standards should be made.     

Use of home care services by elderly Chinese immigrants

Using the Anderson Service model, this study examined the level and predictors of using selected home care services by elderly Chinese immigrants in Canada. Data from 1,537 randomly selected Chinese immigrants aged 65 years and older were used. Only 5.2% of participants reported using home care services. Being older, living alone, having a post-secondary education, immigrating from Hong Kong or Southeast Asia, having a higher level of agreement with Chinese health beliefs, higher social support, and poorer physical and mental health were predictors for home care service use among elderly Chinese. The probability of using homecare services lessens with increased self-rated financial adequacy. These findings point to the need for service providers to address the gap in use of home care between elderly Chinese immigrants and overall elderly Canadians through promoting appropriate use of home care among elderly Chinese immigrants.     

Accommodation for elderly persons in newly industrializing countries: the Hong Kong experience

The newly industrializing countries seem set to follow many developed countries with a rapid growth in numbers of elderly people. This will throw considerable strain on their resources, particularly in the provision of services and accommodation for this group in society. Hong Kong is a leader amongst the newly industrializing countries, both in terms of its aging population (more than 11 percent of its people are now over 60 years of age) and in terms of economic growth. It has, however, only relatively recently embarked upon a comprehensive and integrated program to provide a wide range of accommodation for the elderly. This includes sheltered housing within Hong Kong's well-known public housing schemes, old people's homes, care-and-attention homes, and infirmaries. The private sector has also been growing rapidly in the 1980s with a considerable recent increase of old people's homes. A voluntary code of conduct for this sector was introduced in late 1986, but concerns remain about the quality of care and the rapid growth of private homes in the territory. The approaches to the provision of accommodation for the elderly are set in the context of Hong Kong's overall social policy development. Whilst the experience of relatively wealthy Hong Kong may not prove to be of relevance for the majority of Third World countries, it is argued that it may provide a model for other newly industrializing countries.     

Health care for the elderly: two cases of technology diffusion

Diffusion of medical technology and the growing proportion of elderly people in the population are generally regarded as major contributors to the increasing health care expenditure in the industrialised world. This study explores the importance of one specific factor in this process, the change in the use of technology among elderly patients. In some instances, a new technology is first used among younger patients and then gradually extended to the elderly. Two such cases are studied, both representing costly procedures: coronary bypass surgery (treatment of coronary heart disease) and dialysis (treatment of uraemia). In both cases, we demonstrate significant diffusion to older age groups. It is also tentatively concluded that the diffusion of technology could have an important effect on per capita health care expenditure among the oldest of the old.     

The need for integrated primary health care to enhance the effectiveness of health services

With the increasing prevalence of chronic illnesses and health compromising behaviours, health care expenditure is escalating with the expansion of hospital services. Integrated primary health care would enhance the cost effectiveness of health care delivery. Recent studies on primary care health services research in Hong Kong indicated that there is a high level of inappropriate utilisation of hospital emergency services, a high prevalence of youth health risk behaviours particularly mental health which would lead to a heavy burden on health services in the future. The community based rehabilitation provided a better quality of life for chronic illness patients, better drug compliance for chronic illness patients in family practice, and a disproportionate amount of budget is spent on law reinforcement and treatment for drug abuse rather than on prevention and education. The findings strongly indicate the need to have a strong primary health care team with well trained family physicians and trained health professionals as primary care practitioners to provide services on health promotion; curative; rehabilitation and supporting services; supporting self help activities of individuals, families and groups. This would minimize compartmentalisation in health care delivery, and is also a cost effective way of providing high quality holistic and comprehensive care that meets the needs of the majority of the population.     

香港地区医疗卫生制度变迁及其启示

香港地区的医疗卫生制度由早期的慈善机构提供演进到现在比较完善的架构,其公平性与可及性受到赞誉。但医疗卫生总费用的上升、公共医疗的过度使用、医疗架构的分裂隔离等弊端也日益凸现。在一国两制的框架体系下,反思香港一百多年医疗卫生制度的变迁与实践,我们可以从香港医疗卫生服务的政府主导、"管办分离"、基层医疗卫生服务、农村及边远地区医疗卫生服务等方面得到有益启迪。