Long-awaited health-care policy in sight

Hong Kong is set to unveil a long-awaited policy on health care but there are concerns that a plan to set up clinics to put different services under one roof may create unfair competition among private doctors.

An 87-page document titled 'Primary Care Reform in Hong Kong' outlines steps to gear health-care services more towards prevention, health risk assessment and self-management of chronic illnesses.

It says developing preventive medicine in the city is of utmost importance amid an ageing and growing population.

Key initiatives include encouraging people to build a long-term relationship with family doctors; public and private health-care sectors sharing management of chronic diseases; better self-care; setting up polyclinics; and appointing a director of primary care service providers.

The Hong Kong Medical Association has serious reservations over the plan to set up polyclinics. It says it may create a situation where it is not a level playing field for doctors.

The policy document says: 'The traditional focus of our primary care system has been on providing treatment for acute, episodic diseases and ailments without sufficient emphasis on prevention. This can no longer meet the changing needs of the population.

'Over-reliance on hospital and specialist care for management of common chronic diseases results in long waiting times for public specialist referrals and the public hospital care is often overloaded.'

The policy, to be tabled in the Legislative Council next week, is the result of a two-year discussion by a working group under the Health and Medical Development Advisory Committee. Health officials, doctors, patients' groups, private hospital representatives, private doctors and academics were involved.

Professor Cindy Lam Lo-kuen, head of family medicine at the University of Hong Kong, welcomes the policy after years of government inaction.

'It is an important moment for Hong Kong. It is the first time that the government has committed to such a policy and its implementation beyond lip service,' Lam said.

'Hong Kong has lagged behind some developed countries in term of primary care. Our secondary and tertiary medical services are advanced and we do have public outpatient clinics, but we lack a good system for primary care.' A pilot 'shared-care programme' will be launched later this year to invite private doctors to help treat 22,000 hypertension and diabetes patients by 2012.

Under the programme, in Sha Tin and Tai Po, each patient will receive a maximum government subsidy of HK$1,400 a year to consult private doctors.

This amount covers HK$1,200 in consultations and drug fees, and also an incentive of up to HK$200. The programme also offers HK$200 incentives to the private doctors who meet standards according to clinical guidelines set by the working group.

Dr Donald Li Kwok-tung, Hong Kong Academy of Medicine vice-president and former president of the College of Family Physicians, said the reform was a positive step to enhance primary care in Hong Kong and both patients and service providers needed to modify their behaviour in the future.

'Solo practitioners, for example, used to be totally autonomous in their practice. In the future, they may have to follow some guidelines and meet some standards in order to join some primary care programmes,' Li said.

The working group on primary care also recommends launching a primary care directory by the end of this year covering doctors and dentists. Sub-directories for Chinese medicine practitioners, nurses and allied health professionals would be set up later. The directory would include the background, professional qualifications and practice information of doctors. It would only provide an online version which could be updated frequently.

Doctors would need to take continual medical education to stay on the directory.

Cheung Tak-hai, vice-chairman of the Alliance Patients' Mutual Help Organisations and a working group member, said the directory would only play a supporting role for patients to choose doctors because most relied on word of mouth in finding a doctor.

'People in general will have more confidence in the government-led directory rather than advertisements by individual clinics or hospitals, but in reality, patients rely very much on advice from relatives and friends in deciding which doctors they will go to,' he said.

Cheung said the shared-care programme would be popular with patients who can afford private services and at the same time want to keep their 'account' with public clinics.

The plan to set up community health centres, or polyclinics, will provide one-stop care for patients.

Services such as consultations, physiotherapy, dietitian's consultations, occupational therapy and vaccination programmes will all be under one roof.

The first centre, in Tin Shui Wai, will start operating late next year to serve 55,000 people a year. The government plans at least three more centres in other districts.

The document says the polyclinics could house a general outpatients' clinic, a health centre for elderly patients, a maternal and child health centre, a student health service centre and also a university family medicine clinic.

But Hong Kong Medical Association president Dr Tse Hung-hing said the centres would give an advantage to doctors who practise there.

'We are concerned that the centres will not be a level playing field for all practitioners because the clinics' rents there will be cheaper than that in the private market,' Tse said.

'Doctors there will probably get more patient referrals. It may not be fair to those who do not join the centres.'

The association's former president, Dr Choi Kin, called on the government to provide more resources to implement the policy.

Choi said the government should consult the public on the design of the directory.

'Most primary care doctors have similar qualifications, we should listen to the public to know what information should be put on the directory - such as doctors' experience or interests.'

Lam said the next step would be to introduce life-course health risk assessment. 'The Canadian model is the one we can take reference from, where all citizens have to see their family doctors at least once a year for a health assessment.'

Amid repeated calls for the government to expand its medical care services to dental services at the primary level, the working group will later set up a dental subgroup to make recommendations on dental care services.

A suitable case for treatment

The percentage of people aged 15 or above in Hong Kong who suffer from hypertension is about: 27%

The percentage of the adult population that has diabetes: 10%

Elderly people require more in-patient care than younger people by a factor of: 6

The percentage of people aged 65 or above is projected to rise from 12.7 per cent (0.89 million) to: 26.4% (2.26 million)

Vision of the future primary care system

Everyone has access to a primary care doctor as their long-term health partner

Multi-disciplinary teams to provide care that emphasises prevention of diseases

Everyone is supported in their efforts to improve and take care of their own health

Key strategies

improve continuity of care

improve co-ordination of care among health care professionals

emphasis on patients' empowerment

strengthen infrastructure support

Source: Primary Care Reform In Hong Kong - Strategy Document