Primary healthcare reform finally seems to be emerging as a priority for Hong Kong. The government recently took steps to fortify the system that serves as the first point of contact for individuals and medical professionals, easing an unhealthy reliance on public hospitals. It is encouraging to see the appointment of a seasoned geriatrician and medical professor to head a new Primary Healthcare Office. Dr Pang Fei-chau will oversee the government’s prescribed blueprint for change as the authority’s first commissioner. He is tasked with delivering the sector’s biggest reforms in a decade while coordinating services across the Department of Health, Hospital Authority and the private sector.
The goal of primary healthcare is health promotion, disease prevention and management as well as supportive care. In 2019, Hong Kong set up district health centres and clinics across the city offering health assessments, lifestyle advice and support for chronically ill patients. But the system remains far less robust than what was envisioned in 1990 when the Hospital Authority was launched. While the city’s inpatient care system is one of the best in the world, primary care has languished.
Inpatient, hospital-based secondary care has struggled to serve an ageing population and a prevalence of chronic disease, shortcomings cast in sharp focus by the health challenges of the pandemic. Chief Executive John Lee Ka-chiu acknowledged the “dire consequences” of overreliance on public hospitals in his maiden policy address in October. While calling for renewed primary healthcare reform, Lee has promised a blueprint to reshape the system into something more prevention-focused and community-based.
One challenge will be persuading Hongkongers, in particular the elderly, to shift from an ingrained habit of reliance on hospital treatment. The government has taken steps here too, with plans to increase the value of medical vouchers which require patients to spend on preventive care. A pilot scheme will have district health offices refer people at risk of hypertension and diabetes for screening and treatment by private family doctors, with half the cost borne by the government. An expanded public-private healthcare partnership has enhanced electronic health record sharing and streamlined diagnosis and treatment.
Primary healthcare was discussed by senior officials from around the world at Hong Kong’s recent Asia Summit on Global Health. World Health Organization Chief Scientist Dr Soumya Swaminathan told delegates that communities with robust primary care systems had responded best to the pandemic. Hong Kong’s people and leaders should use lessons of the Covid fight as motivation for change.