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. In a mixed method research grounded on implementation science, assessments have been made on the intervention components in the design and implementation factors in operationalizing of the scheme to inform policy decisions how the scheme can be modified and enhanced for effectiveness. The government issued a Primary Healthcare Blueprint in December 2022, and recommended to further develop a district-based family-centric community health system based on the District Health Centre model. This study will provide insights to enable the development of primary healthcare system in Hong Kong.

(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.

(iv) Cancer care

The Centre has conducted a study of cancer care in Hong Kong, and produced a policy brief (https://hspr.cuhk.edu.hk/news/study-on-cancer-care-in-hong-kong/) to summarize the evidence on 1) the service needs for holistic cancer care, 2) the gaps in public and private provision, 3) the roles of public and private financing and private medical insurance, and 4) the barriers and facilitators in accessing cancer care and population screening services encountered by affected individuals. The study is funded by AIA (Hong Kong). Literature and document reviews, interviews with stakeholders, and questionnaire surveys were used to generate data for evidence synthesis.  The evidence generated serves to inform policy for a cancer care and control strategy in Hong Kong with a focus on prevention and in particular early detection and cancer screening. Prof Yeoh, Centre Director, presented the findings at a press conference on 29 September 2022.

(v) Private medical services

In response to Consumer Council’s invitation, the Centre Director submitted a proposal titled “Survey Research on Private Medical Services and Telehealth Services in Hong Kong” in December 2022, and was awarded by Consumer Council in February 2023 to conduct the study for 10 months. This study aims to examine the scope of services provided by local private medical services providers (i.e. private hospitals and day procedure centres) and their price transparency; and to gauge consumers’ experience and satisfaction in using private medical services and telehealth services; and gauge medical practitioners’ perception on telehealth services.