Introduction
Healthcare expenditure
Who pays the bill?
Where does the money go?
Reasons for high costs
Ageing population
High consumer demand
High technology
System inefficiencies
Overuse of hospitals for healthcare

Introduction
Cost containment efforts
Reducing demand: reimbursement strategies
Reducing demand: management strategies
Cost reduction: competition
Cost reduction: price controls
Market regulation: planning and budget controls
Quality of healthcare
Measures of the quality of healthcare
Availability
Accessibility
Capacity to sustain life
Conformity with state-of-the-art
Treatment not being harmful
Effectiveness
Patients' rights and satisfaction
Information technology

The role of the government
The national government
Prefectural and local governments
Health insurance
Employee health plans
Community-based health insurance
Finance of the insurance system
Insurance benefits
Provision of medical care
Payment
Funding and expenditure
Reasons for higher healthcare expenditures
Ageing population
Change in the nature of illness
Medical technology
Over-use of the healthcare system
Payment system
Management system
The healthcare industry
Healthcare facilities
Healthcare personnel
Private health insurance
Pharmaceutical industry
Biotechnology industry
Quality and approval processes
Drug price system
Drug distribution system
Generics
Medical devices
Quality of healthcare
Availability
Medical care for the elderly
Accessibility
Capacity to sustain life
Conformity with state-of-the-art
Treatment not being harmful
Effectiveness
Patients' rights and satisfaction
Cost containment efforts
Reducing demand: reimbursement strategies
Reducing demand: management strategies
Cost reduction
Market regulation: planning and budget controls
Future proposals

Role of government
Department of Health
Non-regional services
Special health services
Hygiene services
Dental services
Regional health services
Hospital Authority
Funding and expenditure
Reasons for increasing healthcare expenditures
Ageing population
Rising healthcare costs
System inefficiencies
Healthcare industry
Healthcare personnel
Hospitals
Traditional Chinese Medicine
Pharmaceuticals
Health insurance
Medical equipment and healthcare products
Quality of healthcare
Availability
Accessibility
Capacity to sustain life
Conformity with state-of-the-art
Treatment not being harmful
Quality assurance and improvement
Effectiveness
Patients' rights and satisfaction
Cost containment efforts
Reducing demand: reimbursement strategies
Reducing demand: management strategies
The Hospital Authority's management initiatives
Cost reduction: competition
Cost reduction: price controls
Market regulation: planning and budget controls
The 1995 information strategy
Future changes
Search for additional revenue
Percentage subsidy approach
Target group approach
Co-ordinated voluntary insurance approach
Two other approaches 1997: Hong Kong as a special administrative district of China

Role of government
National government
Regional bodies
Local government
Funding and expenditure
Reasons for healthcare expenditure concerns
Reliance on public sector for healthcare services
Dominance of acute hospital care
Demographic changes
Healthcare system inefficiencies
Healthcare industry
Healthcare personnel
Hospitals
Private hospitals and rest homes
Pharmaceutical industry
Manufacturing
Research and development
Trade
Registration and other permits
Subsidies
Generics
Private health insurance
Medical devices
Quality of healthcare
Availability
Distribution
Long-term care
Integration of primary and secondary healthcare services
Accessibility
Capacity to sustain life
Conformity with state-of-the-art
Treatment not being harmful
Effectiveness
Patients' rights and satisfaction
Cost containment efforts
Reducing demand: reimbursement strategies
Reducing demand: management strategies
Cost reduction: competition
Cost reduction: price control
Market regulation: planning
Future change

Description of the healthcare system
The role of government
Commonwealth government
National health insurance
Pharmaceutical benefits
Other Commonwealth programmes
State and territory governments
Local governments
Funding and expenditure
Reasons for high health costs
Population growth
Ageing population
High technology
Inefficiencies in the healthcare delivery system
Healthcare industry
Healthcare personnel
Healthcare facilities
Private health insurance
Industry regulation
Industry summary
Top private health funds
Pharmaceuticals
Pricing regulation
Top pharmaceutical companies
Medical devices and diagnostics
Research and development
Quality of healthcare
Availability
Accessibility
Capacity to sustain life
Conformity with state-of-the-art
Treatment not being harmful
Effectiveness
Patients' rights and satisfaction
Cost containment efforts
Reducing demand: reimbursement strategies
Reducing demand: management strategies
Cost reduction: competition
Cost reduction: price controls
Market regulation: planning and budget controls
Future changes

Quality of healthcare
Cost containment efforts negatively affect quality of healthcare
Future health reforms

Table 1.1: Total healthcare spending as a percentage of GDP 1970-1993
Table 1.2: Per capita healthcare expenditures 1981-1993
Table 1.3: Payers of the healthcare bill
Table 1.4: Distribution of healthcare expenditure
Table 1.5: Age distribution 1960 and 1993
Table 3.1: Functions of health centres and welfare offices
Table 3.2: Japanese health insurance schemes
Table 3.3: Distribution of medical care costs by different age groups 1991 (fiscal year)
Table 3.4: Number of medical facilities and beds 1992
Table 3.5: Worldwide pharmaceutical markets 1990-93
Table 3.6: Sales profits and employees of 20 leading Japanese pharmaceutical manufacturers 1993
Table 3.7: Foreign operations of Japan's pharmaceutical companies 1993
Table 3.8: Number of companies employees and pharmaceutical sales values of foreign pharmaceutical affiliates in Japan 1993
Table 3.9: Drug premiums
Table 3.10: NHI drug price reduction (%) 1981-1994
Table 3.11: Production of medical devices in Japan by group 1994
Table 3.12: Gold Plan goals for 2000
Table 3.13: Changes in medical fees 1983-1994
Table 3.14: One month study of capitation effects
Table 4.1: Estimated healthcare expenditure 1993
Table 4.2: Elderly population in Hong Kong
Table 4.3: Schedule of recommended minimum levels of hospital and surgical coverage October 1994
Table 4.4: General surgical operations on head
Table 4.5: Optical memory card vs smart IC card
Table 4.6: Comparison of daily fees for general ward under different subsidy scenarios 1992-93
Table 4.7: Comparison of daily fees for semi-private rooms under different subsidy scenarios 1992-93
Table 5.1: Healthcare funding and expenditure
Table 5.2: Private hospital beds by hospital type March 1995
Table 5.3: Manufacturers of drugs and medicines 1989-1993
Table 5.4: Pharmaceutical wholesalers 1989-1993
Table 5.5: Financial performance of leading pharmaceutical manufacturers distributors and wholesalers 1994
Table 5.6: Pharmaceutical exports to major trading partners 1989-1993
Table 5.7: Imports from major trading partners 1989-1993
Table 5.8: Manufacturers of medical and surgical equipment and supplies 1989-1993
Table 5.9: Indicative waiting times
Table 5.10: Number of residents in long-term residential care facilities and state funding 1 July 1993
Table 6.1: Summary of current Commonwealth/state roles and responsibilities for healthcare
Table 6.2: Total healthcare expenditure by area of expenditure and source of funds 1990-91
Table 6.3: People employed in the healthcare industry 1986 and 1991 censuses
Table 6.4: Number and percentage of the population with basic private health insurance
Table 6.5: Performance of top health funds 1994
Table 6.6: Cost of Pharmaceutical Benefits Scheme 1993-94
Table 6.7:Estimated number of prescriptions supplied through community pharmacies by category 1990-93
Table 6.8: Exports and imports of pharmaceutical and medicinal products by source/destination 1993-94
Table 6.9: Factor (f) programme data
Table 6.10: Total cost of manufacturers' prices of pharmaceuticals (excluding OTC) 1992-9
Table 6.11: Top 10 suppliers by value of sales 1993-94 from processed PBS prescriptions
Table 6.12: Medical device and diagnostics industry profile 1994
Table 6.13: Employment in medical device and diagnostics industry 1991-94
Table 7.1: Cost containment efforts
Table 7.2: Assessment of quality

Figure 3.1:Organisational chart of Japan's Ministry of Health and Welfare
Figure 3.2: Percentage of insured people and their dependents with major types of health insurance (end March 1993)
Figure 3.3: Medical care insurance finance and payment systems
Figure 3.4: Process from research and development to post-marketing surveillance
Figure 3.5:Distribution system for ethical drugs
Figure 3.6: Japanese exports and imports of medical devices
Figure 3.7: Total production of medical devices Japan 1984-1994
Figure 4.1: Organisation of Hong Kong Department of Health 31 March 1994
Figure 4.2: Organisational structure of the Hospital Authority
Figure 5.1: The structure of the New Zealand healthcare system