Hong Kong scheme for public sector patients to use private health care ‘should be expanded’

A Hong Kong voucher scheme that pays for public sector patients to use private health care services should be scaled up to help with disease prevention and to ease the burden on overloaded government hospitals, an independent think tank has urged.

Our Hong Kong Foundation, formed in 2014 by former Hong Kong leader Tung Chee-hwa, also called for greater investment in primary care, citing data which suggested that every HK$1 worth of resources cut HK$8.40 off the cost of acute and emergency services.

A report by the foundation, released on Friday, examined how the city’s health care system could shift its focus from public hospitals and acute services to more emphasis on community care such as the day-to-day work of family doctors.

The medical system is heavily imbalanced, with public hospitals providing care to more than 90 per cent of inpatients, despite only employing 40 per cent of the city’s doctors.

The government-funded sector has been stretched to a breaking point because of increasing demand and a rapidly ageing population. Patients have often complained of prolonged waiting times and congested public wards.

“Nearly half of hospital admissions in the public sector could be prevented if there were appropriate outpatient, primary and community care in place,” the report said.

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Led by Dr Yeoh Eng-kiong, a former secretary for food and health, the authors said the voucher scheme could be better designed for elderly patients to target chronic disease management and prevention.

The scheme, launched in 2015, provides eligible locals over the age of 65 with a HK$2,000 (US$255) voucher annually to help pay for private health care.

But the scheme was currently unfit for purpose, according to Yeoh, who is now director of the Jockey Club School of Public Health and Primary Care at the Chinese University of Hong Kong.

“What it has done is encourage people to see both public and private doctors, but it hasn’t decreased the workload on the public sector,” he said on Friday.

Most elderly patients seldom used the vouchers for chronic disease management or prevention, he added.

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Improvements were needed to gear the scheme specifically towards check-ups or screening for high blood pressure, diabetes and cholesterol, Yeoh said.

Dr Ho Chung-ping, president of the Hong Kong Medical Association, which represents the city’s doctors, said he supported the scheme, and the government could consider an additional HK$500 voucher for check-ups.

“The government does not need to carry on with this every year. The purpose is to help people develop the habit,” he said.

Although the scheme did need some “fine tuning”, by and large it had helped offer many patients a second opinion or a shortened waiting time outside of the public sector, Ho added.

The report’s researchers also stressed the need to boost manpower and training to ensure a spectrum of primary care providers for the ageing population.

“The one fundamental place to start is with the primary care workforce. Without that, nothing else will happen,” Yeoh said.

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Primary care includes four types of providers: family doctors; generalists trained to deal with multiple chronic illnesses; primary care doctors trained in long-term and palliative care; and specialists who provide primary care.

Hong Kong health minister Professor Sophia Chan Siu-chee, attending the event for the report’s release, said that the government was working towards a system focused on primary care.

“Primary health care is the way forward ... We’re also heading towards triggering a paradigm shift where we want to guide our citizens to focus on prevention as well as promotion of a healthy lifestyle instead of curative services,” Chan said.

A district health centre in Kwai Tsing, slated to open in the third quarter of 2019, was the first step towards this goal across all the city’s 18 districts, she said.

The centre will prioritise treating patients with hypertension, diabetes and obesity, and users will get a government subsidy and caps on fees.

Additional reporting by Karen Zhang