1. Project Partners: Funded by: Societal Age Disparities in Health Care: Observation from HK compared with the UK B Mak, J Woo, A Bowling, F Wong, PH Chau

2. Project Partners: Funded by: 2 Ageing Population & Public Health Expenditure  Ageing population in Hong Kong People over age 65 will increase from 13% in 2009 to 28% in 2039. Ageing population will lead to an increase in chronic disease and disability burden on health care system.  Public health expenditure $37.8 billion in 2004 (14.7% of the total government budget) $186.6 billion in 2033 (27.3% of the total government budget)

3. Project Partners: Funded by: 3 Needs for Prioritization  HK government healthcare budget is unable to keep up with the demand.  Some form of rationing in health services seems to be inevitable.  However, there has been No official acknowledgement of the needs for prioritization Little discussion of this issue among policy makers, professionals and the general public

4. Project Partners: Funded by: 4 The Present Study  Objectives: To examine how HK people view health care prioritization − Older people have a greater health care need than others. − Prioritize older people / elderly services over others? − Any difference between healthcare professionals and the public view of prioritization? To compare the findings with those from a UK survey (Bowling, 1996) − Any difference between HK and UK people?

5. Project Partners: Funded by: 5 Methodology  Survey: An opinion survey was conducted in HK from January to November 2009.  Participants: 1,512 people aged 18+ participated. − 117 of them were healthcare professionals.  Questionnaire: The design was based on the one used by Bowling (1996).

6. Project Partners: Funded by: 6 The Questionnaire (i) 1.Respondents were asked to prioritize 12 health services: − Treatment for children with life threatening illness − Treatment for people aged 75 and over with life threatening illness − Long stay hospital care for elderly people − Special care and pain relief for people who are dying − District nursing and community services / care at home − Treatment for infertility − Psychiatric services for people with mental illness − Surgery, such as hip replacement, to help people carry out everyday tasks − Preventive screening services and immunizations − High technology surgery, organ transplants and procedures which treat life threatening conditions − Health promotion / education services to help people lead healthy lives − Intensive care for premature babies who weigh less than 680g with only a slight chance of survival

7. Project Partners: Funded by: 7 The Questionnaire (ii) 2.Respondents were asked who they thought should set priorities and to select their preference from a list: − Doctors at local level − Hospital mangers − Hospital Authority − Politicians and the government − The public

8. Project Partners: Funded by: 8 Results (i)  Priority Ranking of the 12 Health Services : 1.Treatment for children 2.High technology surgery 3.Preventive screening services 4.Surgery to help people carry out everyday tasks 5.Health promotion / education services 6.Psychiatric services 7.District nursing & community services / care at home 8.Long stay hospital care for elderly people 9.Treatment for people aged >75 10.Special care & pain relief for people who are dying 11.Intensive care for premature babies 12.Treatment for infertility Healthcare professionals vs. General public

9. Project Partners: Funded by: 9 Results (ii)  “If resources are to be rationed, higher priority should be given to treating the young rather than the elderly.” 44% agreed (vs. 34% disagreed)  “Surveys of the general public’s opinions, like this one, should be used in the planning of health services.” 77% agreed

10. Project Partners: Funded by: 10 Results (iii)  Respondents were asked to rank who should set priorities: Doctors at local level (43%) The public (21%) Hospital Authority (19%) Hospital mangers (11%) Politicians and the government (6%)  “The responsibility for rationing health care should rest with doctors.” 48% agreed (vs. 34% disagreed)

11. Project Partners: Funded by: 11 UK Results (iii)  “The responsibility for rationing health care should rest with doctors.” 75% agreed (vs. 15% disagreed)  “Surveys of the general public’s opinions, like this one, should be used in the planning of health services.” 91% agreed  “If resources are to be rationed, higher priority should be given to treating the young rather than the elderly.” 50% agreed (vs. 29% disagreed)

12. Project Partners: Funded by: 12 International Comparison HKUK Treatment for children11 High technology surgery27 Preventive screening services33 Surgery to help people carry out everyday tasks44 Health promotion / education services58 Psychiatric services66 District nursing and community services75 Long stay hospital care for elderly people810 Treatment for people aged >75912 Special care & pain relief for people who are dying102 Intensive care for premature babies119 Treatment for infertility1211

13. Project Partners: Funded by: 13 International Comparison HKUK Treatment for children11 High technology surgery27 Preventive screening services33 Surgery to help people carry out everyday tasks44 Health promotion / education services58 Psychiatric services66 District nursing and community services75 Long stay hospital care for elderly people810 Treatment for people aged >75912 Special care & pain relief for people who are dying102 Intensive care for premature babies119 Treatment for infertility1211

14. Project Partners: Funded by: 14 Discussion (i)  In HK, most people including healthcare professionals give priority to the young over the old in distributing a given amount of health care benefit: Services for the elderly, whether in the community or in hospitals, and including end-of-life, were ranked among the lowest.  Most people think that: General public’s view of prioritization should be used in the planning of health services. The responsibility for rationing health care should rest with doctors.

15. Project Partners: Funded by: 15 Discussion (ii)  HK health care policy needs to acknowledge constraints and the needs for prioritization To meet the needs of ageing societies To meet the needs of all users equitably  The public and professionals should engage with policy makers in formulating a policy based on: Cost benefit considerations Overall societal view of prioritization that is not based on age alone

16. Project Partners: Funded by: 16 Age Disparities in Health Care Q & A