Care of the older Hong Kong Chinese population

The Chinese population of Hong Kong is relatively young in terms of the proportion older than 65 years (9% in Hong Kong [1] compared with 18% in Sweden, 16% in the UK, 13% in the USA and 11.2% in Australia). However, at 76 years for men and 82 years for women, life expectancy is one of the highest in the world [2]. The absolute number of those aged 85 years and over will rise from 30 000 in 1995 to 75000 by 2005 [2]. The approaches the government is taking to the care of this rapidly increasing sector of the population show how measures adopted in other populations may be examined critically and then modified for local use. Faced with these issues later than many Caucasian populations, we have the advantage of seeing the outcome of different health care poliCies in other countries before making such choices ourselves. Here we report the burden of chronic disease and disability, modes of service delivery and health care financing, preventive opportunities and methods of monitoring the outcome of care, as well as considering which approaches adopted from Caucasian communities are appropriate and how they may be modified to ~eet local needs. Currently the government is responsible for 12% of primary care and over 95% of hospital care, while the rest is provided by the private sector. Long-term institutional care is provided by social services and to a small extent the hospital services, the private sector providing more than half. The government and government-aided services are free for those who cannot pay the nominal charges. In 1991, Hong Kong spent only 3.7% of its gross domestic product on health, compared with 8.6% in Sweden, 6.6% in the UK, 13.4% in the USA and 8.6% in Australia [2]. In 1994, the numbers of doctors per 1000 people were 1.27 in Hong Kong, 2.69 in the USA and 1.58 in the UK, while the corresponding numbers of nurses were 5.55, 7.84 and 5.17 and the numbers of hospital beds per 1000 were 4.59,4.33 and 4.85 [2]. Disease and disability burden