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3.3.2 EVALUATING HONG KONG’S EFFORTS IN PPP
PROGRAMMES

The development of PPPs in Hong Kong using publicly funded, privately-provided service
models have generally been in response to demand pressures. Table 3.3 reveals that service
provision of current programmes spans a broad range from primary care, elderly care, and
health promotion to general surgery, cancer treatment and screening. The programmes are
largely disease-oriented and some focus on disease prevention. It is not evident that design
of these PPPs are consistent with the concept of strategic purchasing that seeks to maximise
health system objectives in meeting population health needs and through improvements and
performance of healthcare providers. Analogous to the review of international practices in
Chapter 2, this section reviews the PPPs in Hong Kong according to the synthesised
framework of strategic purchasing which consists of five components: addressing population
health, ensuring citizen and patient empowerment within the health system, strengthening
governance through efficient stewardship and capacity to ensure accountability, developing
effective purchaser and provider organisations, and incorporating cost-effective contracting
(Klasa et al., 2018).

Population health

Identifying population health needs and incorporating them into the purchasing process is a
core element in strategic purchasing decisions. However, in existing PPPs, there does not
appear to be a planning framework for analysing population health needs to
guide the design and development of PPPs, which will increase the health system’s ability to
tackle changing health needs in the medium-to-long term. Most PPPs are designed to fill
existing and foreseeable service gaps in light of growing service demand, targeted at
individual patients and specific diseases, but not populations.

With more than 40,000 participants as of June 2021, the GOPC-PPP is an encouraging effort
to address the escalating burden of chronic disease through enhancing primary care
provision by diverting primary care service load from the public into the private sector.
However, the service scope is limited to only patients, with hypertension and/or DM, with or
without hyperlipidemia deemed clinically stable, already using HA services. The restrictive
eligibility requirements are inadequate to meet PHC needs of the entire population.

At the same time, the EHCVS presents citizens aged 65 years and above with an additional
choice to use subsidised primary care services in the private sector (HKSARG, 2020c).
However, the vouchers have been mainly utilised for acute episodic care and not for chronic
disease management and have encouraged dual utilisation of both public and private care.
There are also no similar schemes designed for populations from other age groups that will
incentivise primary care uptake, and in particular, none for younger age groups wherein
chronic health conditions are deemed to be more preventable and early detection allows for
more timely intervention.

Citizen empowerment

Citizen empowerment is achieved through ensuring that patients’ views and values
are asserted, purchaser accountability is enforced, and that citizen
choice is increased (Klasa et al., 2018). The strategic purchasing framework advocates
that government and purchasers should ensure that citizens’ and patients’ values, views, and
choices are accounted for. To do so, citizens should be allowed input on their benefit
package, their choice of provider, and ability to hold purchasers and providers accountable
for services offered.

While Hong Kong PPPs provide patients with an extensive choice of service providers, the
level of citizen participation in determining the benefits of PPP programmes is limited. In

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