The health system in Hong Kong, as in many other developed countries, is facing increasing pressure arising from demands of an ageing population with a high prevalence of chronic diseases requiring lifelong health care. Health systems have been designed for acute care and have been unable to fulfil the requirements of providing life-long care for chronic disease management in integrated care provided in different institutional settings and facilities. Inadequate ambulatory care and community resources directly result in pressures experienced in the inpatient setting because avoidable hospitalisations are not dealt with early enough and discharge is delayed by inadequate community-based care.

Hong Kong has parallel systems of public and private financing and provision of healthcare. The segmented public-private financing and delivery system is structurally inefficient and has been under increasing pressure to meet the demands and needs of an ageing population arising from the associated prevalence of chronic disease and issues relating to equity in access to primary care. Given the under provision of public primary care services, financial barriers created by out-of-pocket payments in the private sector make accessibility to and affordability of healthcare an issue for patients in lower socio-economic groups.

Hong Kong’s Health System: “Fit-for-purpose”

(i) Strategic purchasing in public-private partnership

In collaboration with Our Hong Kong Foundation (OHKF), the Centre have been researching policy intervention which address the challenges of ensuring Hong Kong’s health system in “fit-for-purpose” and completed studies on strategies and instruments to enable this.

Centre has launched a study report on how to strategically organize Hong Kong’s health financing system, titled “Strategic Purchasing: Enabling Health for All”, during a symposium held on 20 December 2021 to actualise “Health for All” in a primary care-led people centred integrated care. Building on the 2018 health policy report “Fit for Purpose: A Health System for the 21^st Century”, the latest report pointed out that Hong Kong’s health system is yet to be fit to cater for the emerging healthcare demands shaped by the needs of a rapidly ageing population and growing chronic disease burden. Key findings highlighted the importance for available resources within Hong Kong’s current health financing portfolio to be allocated more strategically for the critical health system goal for transformation to a primary care-led integrated person-centred health system.

Various studies have been conducted to assess the impact of the Elderly Health Care Voucher Scheme on service utilization and primary care system, and to identify factors that influence its implementation since its launch in 2009. Mixed methods employing quantitative and qualitative studies were employed.  Various papers have been published in international peer-reviewed journals.

(ii) Primary care ecosystem

The District Health Centre Scheme (DHC) was proposed in the Hong Kong SAR Chief Executive’s Policy Address in 2017 to promote individual and community involvement, enhance coordination among various medical and social sectors, and strengthen district‑level primary healthcare services. We have been awarded a contract by the Food and Health Bureau (FHB) to monitor and evaluate the Kwai Tsing District Health Centre. We have also been invited by FHB to extend the evaluation of the scheme to the second District Health Centre in Sham Shui Po. The study examines the role of DHC in its primary care ecosystem necessary to transform our health system.  It assesses the implementation process and effectiveness of DHCs using a formative evaluation approach. It will provide insights to enable successful scale-up of the DHC Scheme to other districts and sustainability of the initiative.

(iii) Study on post discharge support and long term care

In view of the ageing population, the demand for long-term care has been outstripping the supply. The Director of the Centre have been contracted by Social Welfare Department (SWD) in end 2017 to conduct an evaluation study on Pilot Scheme on Residential Care Services Vouchers which provides subsidy and choice to elderly persons to seek residential care services in non-subsidised elderly homes.  The results have facilitated the government to refine the voucher scheme and extended it for another three years. SWD further contracted us in October 2020 to conduct another evaluation study on this extended Pilot Scheme to assess its effectiveness and long-term development. SWD also contracted us in June 2018 to conduct an evaluation study on Pilot Scheme on Support for Elderly Persons Discharged from Public Hospitals after Treatment which aims to provide transitional care to prevent premature long-term institutionalisation in residential care homes for the elderly. The evaluation results also enabled the government to develop a new service delivery model for an extension of the Pilot Scheme for three years. We are currently conducting a further evaluation study for this Extended Pilot.