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Hong Kong, complaint mechanisms are generally in place for professional misconduct,
particularly in the public sector. Purchasers’ accountability is limited due to limited citizen
participation in designing and making purchasing decisions in PPP programmes and
inadequate quality management of private providers. To strengthen citizen and patient
empowerment, purchasers’ accountability should be strengthened.

Regarding beneficiary choice, the two primary care PPP programmes have divergent
characteristics on patient choice that indirectly impact the patient health outcomes,
behaviours and ability to manage their health conditions. For the GOPC-PPP, barriers for
private doctor participation such as additional workload and unattractive financial incentives
could in turn limit patients’ choices of primary care service providers they could seek care
from in the private sector. On the other hand, the EHCVS enables patients to use services
from a broad spectrum of healthcare providers, from medical practitioners, Chinese medicine
practitioners, to optometrists. While citizens enjoy having the choice to choose from a wide
array of primary care service providers, without enough guidance and information, the lack of
targeted and clear benefit package design of the EHCVS has manifested into misuse of
voucher credit for products and services beyond the intended scope of private sector
primary care provision. For example, a previous review found that EHCVS participants mostly
used the voucher for managing acute episodic conditions (HKSARG, 2020c). Feedback from
beneficiaries was that the voucher amount was not adequate for chronic disease
management and participants were not familiar with the range of preventive service available.
This reflects the lack of consideration for the most relevant needs of citizens for preventive
care and chronic disease management that could have been solicited from a citizen-
participatory design process.

Strengthen government stewardship & capacity
To build an effective strategic purchasing system, the regulation and monitoring of
purchasers and providers to ensure that they are meeting health
objectives is the key. To achieve these goals, health systems adopt an integrated and
centralised framework that builds upon explicit contractual terms, and ensures enough
government credibility to enact and enforce change should further current purchasing
arrangements be insufficient for achieving health goals.

There does not appear to be a defined regulatory framework with predefined monitoring
mechanisms of PPPs in Hong Kong. As a result, the role delineation between purchasers and
providers remains without a regulatory framework which defines the roles of different
purchasers and the obligations of providers (contractual enforcement could be problematic).

Furthermore, government evaluation of PPPs are not transparent given that the latest publicly
accessible reports are relatively dated. Amongst analysed PPPs, evaluations published by
academic institutions applying a structured evaluation framework are the HD PPP study
conducted by the University of Hong Kong between 2014-2016, the Elderly Health Care
Voucher Scheme review conducted by The Jockey Club School of Public Health and Primary
Care, the Chinese University of Hong Kong (CUHK-JCSPHPC) in 2020, the only other
independent review of HA’s PPP programmes was conducted by the Audit Commission and
released in 2012. Recommendations of this independent review are summarised in Box 3.9.
Authors of the HD PPP Study highlighted that the need for a formal, independent and
rigorous evaluation for the programme to reach its desired goals on patient care, supporting
the importance of regular evaluation (Chen et al., 2016).

Given Hong Kong’s fragmented and pluralistic health system, and the large proportion of
private financing for PHC, the Government’s current capacity to monitor the performance of
primary care PPP providers is foreseeably limited and must be enhanced in a regulatory
framework.

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