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Background. The Health and Health Services Research Fund (HHSRF) is dedicated to support research related to all aspects of health and health services in Hong Kong. We evaluated the fund's outcomes and explored factors associated with the translation of research findings to changes in health policy and provider behaviour. Methods. A locally suitable questionnaire was developed based on the "payback" evaluation framework and was sent to principal investigators of the completed research projects supported by the fund since 1993. Research "payback" in six outcome areas was surveyed, namely knowledge production, use of research in the research system, use of research project findings in health system policy/decision making, application of the research findings through changed behaviour, factors influencing the utilization of research, and health/health service/economic benefits. Results. Principal investigators of 178 of 205 (87%) completed research projects returned the questionnaire. Investigators reported research publications in 86.5% (mean = 5.4 publications per project), career advancement 34.3%, acquisition of higher qualifications 38.2%, use of results in policy making 35.4%, changed behaviour in light of findings 49.4%, evidence of health service benefit 42.1% and generated subsequent research in 44.9% of the projects. Payback outcomes were positively associated with the amount of funding awarded. Multivariate analysis found participation of investigators in policy committees and liaison with potential users were significantly associated with reported health service benefit (odds ratio [OR]participation= 2.86, 95% confidence interval [CI] 1.28-6.40; ORliaison= 2.03, 95% CI 1.05-3.91), policy and decision-making (ORparticipation= 10.53, 95% CI 4.13-26.81; OR liaison= 2.52, 95% CI 1.20-5.28), and change in behavior (OR participation= 3.67, 95% CI 1.53-8.81). Conclusion. The HHSRF has produced substantial outcomes and compared favourably with similar health research funds in other developed economies. Further studies are needed to better understand the factors and pathways associated with the translation of research findings into practice. © 2007 Kwan et al; licensee BioMed Central Ltd. ; published_or_final_version

This report presents the latest estimates of Hong Kong domestic health spending for fiscal years 1989/90 to 2006/07, cross-stratified and categorised by financing source, provider, and function. Total expenditure on health (TEH) was HK$75 048 million in fiscal year 2006/07, which represents an increase of HK$4405 million or 6.2% over the preceding year. Represented as a percentage of gross domestic product (GDP), TEH increased from 3.6% in 1989/90 to 5.6% in 2003/04 and then decreased to 5.0% by 2006/07. Taking population growth into account, total health spending per capita (at constant 2007 prices) grew at an average annual rate of 5.1%, which was faster than the average annual growth rate of per capita GDP by 2.1 percentage points. In 2006/07, government financing of health expenditure was HK$37 417 million (49.9% of TEH), which was the first time it was surpassed by private spending (HK$37 631 million) in the last decade as a result of the continued growth of private spending (averaging 9.5% per annum in real terms since 2002/03). The second important source of health financing was out-of-pocket payments by households (35.2%), followed by employer-provided medical benefits (7.4%) and private insurance (5.6%). Private insurance has taken on an increasingly important role for financing private spending, whereas household and employer expenditure together has shown a corresponding decrease during the same period. Of the HK$75 048 million total health expenditure in 2006/07, current expenditure comprised HK$71 888 million (95.8%), whereas HK$3161 million (4.2%) was for capital expenses (ie investment in medical facilities). Analysed by health care function, services for curative care accounted for the largest share of total health spending (66.2%) which was made up of ambulatory services (35.2%), in-patient curative care (27.1%), day patient hospital services (3.4%), and home care (0.5%). In response to the escalating demand for private health care, private hospitals had increased capital expenditure leading to an observed increase in investment in medical facilities from 2.2% to 4.2% of total spending over the period 2002/03 to 2006/07. Analysed by health care provider, hospitals accounted for the largest share (42.7%) and providers of ambulatory health care the second largest share (30.9%) of total health expenditure in 2006/07. The downward trend in hospital share after 2002/03 was primarily driven by the reduced public spending on hospitals, albeit with continued growth in corresponding private spending since 1997/98. Meanwhile, expenditure at providers of ambulatory services accounted for an increasing share of health spending after 2003/04, mainly due to increases in the volume and expenditure for private services. Not taking into account capital expenses (ie investment in medical facilities), public current expenditure on health amounted to HK$35 437 million (49.3% of total current expenditure) in 2006/07 with the remaining HK$36 451 million made up of private sources of funds. Expenditure on hospital care (HK$32 069 million) was predominately funded by general government revenue (83.8%), whereas that on providers of ambulatory health care (HK$23 201 million) was by private household out-of-pocket payments (67.3%). This reflects the mixed health care economy of Hong Kong, where public hospitals generally account for about 90% of total bed-days and private doctors (including western and Chinese medicine practitioners) provide about 70% of the out-patient care. Although both public and private spending were mostly expended on personal health care services and goods (92.2% of total spending), the distributional patterns among functional categories differed. Public expenditure was targeted at in-patient care (53.3%) and substantially less at out-patient care (24.4%), especially first-contact care. In comparison, private spending was mostly concentrated on out-patient care (48.7%), whereas medical goods outside the patient care setting (22.4%) and in-patient care (18.9%) comprised the majority of the remaining share. Compared to the Organisation for Economic Cooperation and Development countries, Hong Kong has devoted a relatively low percentage of GDP to health care in the last decade. As a share of total spending, public funding (either general government revenue or social security funds) was also lower than in most comparably developed economies, although commensurate with its public revenue collection base. ; published_or_final_version

This report presents the latest estimates of Hong Kong domestic health spending between fiscal years 1989/90 and 2005/06, cross-stratified and categorised by financing source, provider, and function on an annual basis. In fiscal year 2005/06, total health expenditure was HK$71 557 million. In real terms, it grew 6.5% per annum on average throughout the study period, whereas gross domestic product grew 4.1%, indicating a growing percentage of health spending relative to gross domestic product, from 3.5% in 1989/90 to 5.1% in 2005/06. This increase was largely funded by public spending, which rose 8.2% per annum on average in real terms, compared with 5.1% for private spending. This represents a growing share of public spending from 40.2% to 51.6% of total health expenditure during the period. Public spending was the dominant source of health financing in 2005/06, whereas private household out-of-pocket expenditure accounted for the second largest share (34.5%), followed by employer-provided group medical benefits (7.5%), privately purchased insurance (5.1%), and other private sources (1.3%). Of the HK$71 557 million total health expenditure in 2005/06, HK$68 810 million (96.2%) was on current expenditure and HK$2746 million (3.8%) on capital expenses (ie investment in medical facilities). Services of curative care accounted for the largest share (67.3%) and were made up of ambulatory services (35.7%), in-patient services (27.7%), day patient hospital services (3.4%), and home care (0.6%). The second largest share was spending on medical goods outside the patient care setting (10.8%). In terms of health care providers, hospitals (44.0%) accounted for the largest share of total health expenditure in 2005/06, followed by providers of ambulatory health care (31.4%). We observed a system-wide trend towards service consolidation at institutions (as opposed to free-standing ambulatory clinics, most of which are staffed by solo practitioners). Not taking capital expenses (ie investment in medical facilities) into account, public current expenditure on health amounted to HK$34 849 million (50.6% of total current expenditure) in 2005/06, most of which was incurred at hospitals (76.3%), whereas private current expenditure (HK$33 961 million) was mostly incurred at providers of ambulatory health care (55.8%). This reflects the mixed health care economy of Hong Kong, where public hospitals generally account for about 90% of total bed-days and private doctors (including western and Chinese medicine practitioners) provide about 70% of out-patient care. Although both public and private spending were mostly expended on personal health care services and goods (93.0%), the patterns of distribution among functional categories differed. Public expenditure was targeted at in-patient care (53.7%) and substantially less on out-patient care (24.6%), especially low-intensity first-contact care. In comparison, private spending was concentrated on out-patient care (49.9%), followed by medical goods outside the patient care setting (22.0%) and in-patient care (19.0%). Compared to countries of the Organisation for Economic Co-operation and Development, Hong Kong has devoted a relatively low percentage of gross domestic product on health services in the last decade. As a share of total spending, public funding (either general government revenue or social security funds) was also lower than in most comparably developed economies, although commensurate with its public revenue collection base. ; published_or_final_version