Public health services (SUS) are free of charge and include medication (anticholinesterases). Those using the private sector may have health insurance which can be paid by employers or privately by themselves. It is also usual, for those who can afford it, to go directly to a well-known specialist for diagnosis and to pay the doctor directly for the consultation (usually very expensive). Sometimes, people do that in the beginning but end up in the public services as they cannot afford subsequent consultations or exams.

Yes. For public healthcare services, 5% of the cost has to be covered by users and the remaining 95% is subsidised by the Government (Food and Health Bureau, 2010). Individuals with more financial difficulties may apply for medical fee waiver such that there will be no out-of-pocket payments when using public healthcare services (Hospital Authority, 2019d). The service fees of public services offered by the Hospital Authority and commonly used by people with dementia are specialist outpatient (HK$135 for the 1st attendance, $80 per subsequent attendance, $15 per drug item), general outpatient ($50 per attendance), geriatric day hospital ($60 per attendance) and rehabilitation day hospital services ($55 per attendance) (Hospital Authority, 2020d).

For private healthcare services, the Hong Kong Medical Association has been conducting surveys on doctors’ fees every four years since 1991, with the aim to gather information on the prevailing charges of medical services in the private sector. According to the latest survey conducted in 2018 (Hong Kong Medical Association, 2019), the median service charge (medication inclusive) of specialists for regular clinic consultation and psychiatry consultation (half-hour) are $800 and $900 respectively. Under the Health Care Voucher Scheme implemented by the Government, older adults age over 65 may make use of the annual voucher amount of $2000 to cover their medical expenses in the private sector.

For public social care services, under the Dementia Community Support Scheme, people with dementia can receive care and support services, training and carer support services provided by District Elderly Community Centres (operated by NGOs). Recipients of Comprehensive Social Security Assistance or Old Age Living Allowance, and holders of medical fee waiver can receive free-of-charge service. Other users have to pay $150 per month to receive support under this scheme (Food and Health Bureau, 2019a). For other care services provided by NGOs under governmental subvention, most of the services are free-of-charge or they charge a very small amount.

For care services provided by dementia-specific service centres operated by self-financing NGOs, people with dementia will experience a higher amount of out-of-pocket payments. For instance, according to the Hong Kong Alzheimer’s Disease Association, the service fee of day care services is $340 – 420 per day (meals included) (Hong Kong Alzheimer’s Disease Association, 2020b); while according to the Jockey Club Centre for Positive Ageing, the service fee of day care services is $435 – 565 per day (meals included) (Jockey Club Centre for Positive Ageing, 2020b).

References:

Food and Health Bureau. (2010). My Health My Choice – Healthcare Reform Second Stage Consultation Document. Retrieved from https://www.myhealthmychoice.gov.hk/pdf/consultation_full_eng.pdf

Food and Health Bureau. (2019a, 4 June, 2019). Dementia Community Support Scheme. Retrieved from https://www.fhb.gov.hk/en/press_and_publications/otherinfo/180500_dcss/dcss_index.html

Hong Kong Alzheimer’s Disease Association. (2020b). Services – Day Centres. Retrieved from https://www.eng.hkada.org.hk/day-centres

Hong Kong Medical Association. (2019). Hong Kong Medical Association Doctors’ Fees Survey 2018. Retrieved from Hong Kong: https://www.thkma.org/pressrelease/details/20190125_a1.pdf

Hospital Authority. (2019d). Waiting Time for New Case Booking at Psychiatry Specialist Out-patient Clinics. Retrieved from https://www.ha.org.hk/visitor/ha_visitor_index.asp?Content_ID=214197&Lang=ENG&Dimension=100&Parent_ID=10053

Hospital Authority. (2020d). Service Guides – Fee and Charges. Retrieved from https://www.ha.org.hk/visitor/ha_visitor_index.asp?Parent_ID=10044&Content_ID=10045&Ver=HTML

Jockey Club Centre for Positive Ageing. (2020b). Service – Day Care Service. Retrieved from https://www.jccpa.org.hk/en/service/day_care_service/index.html

Most dementia related services are financed through out-of-pocket payments (Bharat and Rao, 2013).

References:

Bharath, S., Sadanand, S., Kumar, K.J., Balachandar, R., Joshi, H., Varghese, M., 2017. Clinical and neuropsychological profile of persons with mild cognitive impairment, a hospital based study from a lower and middle income country. Asian J. Psychiatr. 30, 185–189. https://doi.org/10.1016/j.ajp.2017.10.007

There is no information available. We searched via Medline, PubMed, GoogleScholar, Factiva, news, and Neurona.

There is no dementia-specific monitoring system in Jamaica. However, preliminary findings gathered from the STRiDE Jamaica team indicate that people living with dementia experience out-of-pocket expense to access care. Specifically, dementia care is not subsidised by the public sector, therefore individuals either access care through private insurance or pay-out-of-pocket.

Apart from Makueni county and the four counties where Universal Health Care (UHC) has been implemented for the pilot (see Part 2, Health System Organisation for details on the exception of fees for people aged 70 and over), all persons requiring medical attention irrespective of their age or illness have to pay hospital fees (consultation, laboratory tests, medications, etc.) across Kenyan health facilities. Data from the 2013 nationally representative Kenya Household Expenditure and Utilization Survey revealed a mean annual spending of 5325.12 Kenya shillings and 941.04 Kenya shillings for outpatient services and hospital admissions respectively. Transport costs to and from the health facility (1966.67 Kenyan shillings) formed nearly a quarter of total costs incurred to access health care services (Barasa et al., 2017). These out-of-pocket expenses from the household survey are not specific to dementia but apply to any person accessing health care. The difference in cost of care depends on the level of hospital, distance to the hospital, and cost of medication. Patients do not pay at lower-level health facilities to receive care unless there are medications unavailable at the facility. If the latter case applies, they receive a prescription to buy the medications outside the health facility.

Even though the government has promised senior citizens free medical insurance, this has not taken effect since January 2018. This is due to a delay by the State Department of Social Protection in submitting the list of citizens aged 70 and above to the Ministry of Health. As a result, senior citizens are turned away on arrival at accredited health facilities if they are unable to pay for the services (Igadwah & Kabale, 2019). Other individuals (below 70 years) with dementia regardless of age still pay out-of-pocket expenses to cater for consultation, laboratory tests, and medications in health facilities where UHC is not being implemented unless they have a health insurance.

References:

Barasa, E. W., Maina, T., & Ravishankar, N. (2017). Assessing the impoverishing effects, and factors associated with the incidence of catastrophic health care payments in Kenya. International Journal for Equity in Health, 16(1), 31. https://doi.org/10.1186/s12939-017-0526-x

Igadwah, L., & Kabale, N. (2019). Payroll hitch delays free NHIF for senior citizens. Business Daily, March 2019. Nairobi, Kenya. https://www.businessdailyafrica.com/bd/economy/payroll-hitch-delays-free-nhif-for-senior-citizens-2243904

As there are no public dementia care strategies in place, there is a large proportion of individuals who incur in large out-of-pocket payments by going to private services from the moment they experience memory concerns, and for the whole of their diagnosis, treatment and care. There is no data available on the size of out-pocket payments.

The majority of dementia diagnoses are made in primary care, and this usually carries an additional fee to top up the government subsidy for primary care. There is no cost to those assessed in secondary or specialist care.

As detailed in the overview of the health system (part 2) and long-term care system (part 3), New Zealand provides a universal health care system that funds most dementia care services, but there are some services that are means/asset tested.

If access to adequate care and treatment via the public sector is not possible, people tend to seek help from the private sector at their own expense. There is however no data found on to what extent out-of-pocket expenses are undertaken with regard to accessing diagnosis, care and treatment for dementia specifically (no dementia and dementia-care surveillance in South Africa).