Covid-19 has only reinforced the need for better healthcare in Hong Kong. John Lee must ride the reform wave

Amid talk of a ‘new chapter’ for Hong Kong, officials must not forget promises made by the previous administration to strengthen primary healthcare, and build on its successes

Pamela TinandSophie Qi

Published: 6:30am, 22 Jul, 2022

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In his inaugural speech, Chief Executive John Lee Ka-chiu promised to start a new chapter for Hong Kong by strengthening governance and development of the city. In this new chapter, the administration must not forget old promises – including the pledge to strengthen Hong Kong’s primary healthcare system.

The Covid-19 pandemic has highlighted the resource and manpower limitations within our health system, particularly in the public sector.

But these challenges are not new: long waiting times, especially for specialist services, overcrowded emergency rooms and chronic medical personnel shortages have long characterised Hong Kong’s public healthcare. Among the many lessons learned from the pandemic is the urgent need to enhance primary healthcare.

Advocates have long maintained that a strong primary healthcare system can alleviate demand for specialist services, ensure that more people have timely access to care, and improve the overall quality of care. Consequently, for more than three decades, Hong Kong has explored ways to strengthen its primary healthcare.

The previous administration put primary healthcare development at the top of its health policy agenda. In November 2017, a steering committee was established to develop a blueprint for development of services. Yet, so far, only a framework for the blueprint is ready, outlining five key policy directions.

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The new administration must build on the reform momentum and set out a detailed development blueprint, considering transformation across all levels of the healthcare system and including tangible timelines and performance indicators.

It is worth noting that the framework for the blueprint emphasises strengthening primary healthcare governance. In line with this, the previous administration showed an interest in adopting a strategic purchasing framework for healthcare financing.

Broadly speaking, strategic purchasing optimises healthcare spending by allocating resources to interventions and services that best fulfil population needs while considering cost-effectiveness. The new administration should implement a strategic purchasing framework to make well-informed decisions. Existing and new initiatives should be monitored and evaluated.

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Among its primary care initiatives, the previous administration established the first district health centre in 2019, and enhanced the Elderly Health Care Voucher Scheme that encourages the use of primary care services in the private sector.

Although these are steps in the right direction, there are some limitations. For example, the centres could better realise their potential as district health hubs by strengthening links with other community and healthcare services.

Similarly, although some 97 per cent of the eligible population have used elderly healthcare vouchers, a 2019 Food and Health Bureau report showed that in 2017, most were spent on acute conditions (54 per cent), as opposed to preventive care (13 per cent) or rehabilitation (5 per cent). This shows the need to improve the scheme to better promote key elements of primary care, including preventive care.

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In addressing the shortcomings of existing programmes, the new administration must also strive to meet people’s needs by exploring evidence-based policy ideas.

For example, in line with the principle of strategic purchasing, Our Hong Kong Foundation has proposed a chronic disease screening voucher and management scheme, to screen residents aged between 45 and 54 for hypertension, diabetes and high cholesterol. It is designed to target specific health conditions in this age group to shift the focus of healthcare from treatment to prevention and early detection.

This scheme has the potential to better leverage private-sector service provision and, importantly, to improve the population’s health through earlier access to quality care.

An administration’s first 100 days often provide an insight into its efficacy and policy direction. The previous administration should be applauded for making primary healthcare development a key focus, and its vision for healthcare growth should not go unnoticed.

John Lee’s administration must build on the momentum for healthcare development and unveil a comprehensive blueprint as soon as possible. This is the only way for Hong Kong to have a chance of achieving a sustainable healthcare system in the long term.

Dr Pamela Tin is head of healthcare and social development at Our Hong Kong Foundation, where Sophie Qi is a research intern