RESEARCH & CONSULTANCY

Health system and policy research

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.

In addition, Hong Kong’s health system is segmented and compartmentised in financing and delivery. It has parallel systems of public and private financing for healthcare. The segmented public-private financing and delivery system has been under increasing pressure to meet the demands and needs of an ageing population for equity in access particularly for primary care. Given the under provision of public primary care services, financial barriers created by out-of-pocket payment make accessibility to and affordability of services in the private sector as an issue for the health system. 

 

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.  The studies will be incorporated in a health policy document entitled “Health Financing in the 21st Centre: Public-Private Levers in Strategic Purchasing” to be launched on 20 December 2021. The study assesses the role of strategic purchasing of healthcare to meet population needs in the context of a Public-Private healthcare Partnership (PPP), health-related Sustainable Development Goals and Universal Health Coverage advocated by the United Nations.

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 by the Government 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.