The Contribution of Ageing to Hospitalisation Days in Hong Kong: A Decomposition Analysis Key Messages

Abstract Background: Ageing has become a serious challenge in Hong Kong and globally. It has serious implications for health expenditure, which accounts for nearly 20% of overall government expenditure. Here we assess the contribution of ageing and related factors to hospitalisation days in Hong Kong. We used hospital discharge data from all publicly funded hospitals in Hong Kong between 2001 and 2012. Methods: A decomposition method was used to examine the factors that account for the change of total hospitalisation days during the two periods, 2001-2004 and 2004-2012. The five factors include two demographic factors -population size and age-gender composition -and three service components -hospital discharge rate, number of discharge episodes per patient, and average length of stay (LOS) -which are all measured at age-gender group level. In order to assess the health cost burden in the future, we also project the total hospitalisation days up to 2041, for a range of scenarios. Results: During the decreasing period of hospitalisation days (2001)(2002)(2003)(2004), the reduction of LOS contributed to about 60% of the reduction. For the period of increase (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012), ageing is associated with an increase in total hospitalisation days of 1.03 million, followed by an increase in hospital discharge rates (0.67 million), an increase in the number of discharge episodes per patient (0.62 million), and population growth (0.43 million). The reduction of LOS has greatly offset these increases (-2.19 million days), and has become one of the most significant factors in containing the increasing number of hospitalisation days. Projected increases in total hospitalisation days under different scenarios have highlighted that the contribution of ageing will become even more prominent after 2022. Conclusion: Hong Kong is facing increasing healthcare burden caused by the rapid increase in demand for inpatient services due to ageing. Better management of inpatient services with the aim of increasing efficiency and reducing LOS, avoidable hospitalisation and readmission, without compromising patient satisfaction and quality of service, are crucial for containing the rapid and enormous increases in total hospitalisation days for Hong Kong. The results would be relevant to many rapidly ageing societies in this region. Implications for policy makers • We quantified the changes in hospitalisation days empirically into various components, using a decomposition analysis. Ageing was found to make the strongest contribution to increasing inpatient demand, and will continue to do so. • The increasing demand for inpatient services due to ageing is a predictable and inevitable phenomenon. Adequately managing length of stay (LOS) in hospital and reducing avoidable hospitalisation and readmission are important, to contain the rate of increasing inpatient demand. Among these, LOS seems to have the largest possibility of further reduction. • The methodology in this paper can readily be adopted in other settings, to assess the contribution of ageing, so that more focused and targeted measures can be developed. Implications for the public In this paper, we made use of data from all publicly funded hospitals in Hong Kong, which has a rapidly ageing population, to quantify empirically and illustrate how changes in population and hospitalisation patterns have affected the demand for inpatient services, as measured by total hospitalisation days. In particular, ageing and population growth would have tremendously increased total hospitalisation days during the past decade, but this increase was offset by the decrease in length of stay (LOS) per hospital visit. However, the effectiveness of measures to reduce LOS has plateaued and ageing is predicted to become much more significant in increasing inpatient demand in the future. Further reduction in LOS, avoidable hospitalisation, and readmission rates, with no adverse influence on the quality of care and patient satisfaction, is crucial to mitigate the high financial pressures on healthcare arising from an ageing population