Easing the pressure on Hong Kong’s health sector starts with effective public-private partnership

The alarming rate of hospital bed utilisation in Hong Kong amid a seasonal flu surge is being widely covered and hotly discussed (“Hospital wards packed like Chinese restaurants, doctors complain”, January 25). However, primary health care in Hong Kong is not doing enough to alleviate the pressure on hospitals. The reasons for this minimal contribution lie deep in the structure of the health care system.

The current public-private market share for primary care (outpatient) services is about 3:7 and that for hospital services is 9:1 . This contrast is telling. First, because of the long-term financial burden, private GPs are seldom an appealing choice for patients with chronic illnesses (such as diabetes, chronic kidney disease, etc) who are known to be highly vulnerable to acute health problems, especially during peak flu seasons like the current one.

However, public clinics, with their limited scale, are not able to provide care to all these patients, thus increasing their risk of hospitalisation. In other words, without a comprehensive health care financing programme for citizens, the private sector is not adequate to provide primary care to those most at risk.

This problem has proven extremely difficult to address. Since the early days after the handover, there have been ongoing debates on health care financing but no consensus has been reached. The out-of-pocket payment remains high.

Another way to resolve the problem is an ambitious expansion of public primary care services, but this would increase the regular expenses of the government substantially and so is not very feasible either.

To harness the power of the private market to care for the people most in need, a public-private partnership is a sensible approach. The Kwai Tsing District Health Centre initiative introduced last year to provide primary care services works under a similar concept, except that, I suspect, the contract may not be sufficiently attractive to the intended operators.

My suggestion would be to allow private physicians to run the clinic for profit for specific types of services (such as paediatrics, gynaecology, etc) but also require them to provide care to patients with chronic illnesses at an affordable preset level of fees. That way, the partnership is both profitable and effective in providing quality primary care.

Francisco T.T. Lai, PhD candidate in public health, the Chinese University of Hong Kong