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In sum, we conclude that Hong Kong’s current PPP programmes do not meet the definitions
of strategic purchasing due to the aforementioned pitfalls. As discussed in Chapter 2,
effective strategic purchasing programmes entail multidimensional policy issues from
governance, information system support, benefit design, payment means, alignment and
dynamic management. In light of these key enablers, the refinement of existing PPPs and
development of new PPPs should strive to meet these criteria. In particular, in exploring the
introduction of PPPs to promote primary care uptake, the Government should draw up a
cohesive and evidence-based policy framework for using PPPs that is coupled with
consistent follow-up and review mechanisms to ensure that PPPs are in line with WHO
strategic purchasing principles.

3.4 CONCLUSION

With the private sector contributing to most of the PHC spending, our analysis indicates that
Hong Kong’s public sector is not investing in PHC sufficiently or strategically. Given Hong
Kong’s ageing population, it is of great urgency that the local health system moves beyond
reliance on the already overburdened public sector in the provision of primary care services.
Instead, our government has been committed to engaging the private sector with PPPs as
one of the main actions, and has invested a large amount of the government budget
comparable to spending on public healthcare services. However, the development of PPPs in
Hong Kong is largely fragmented and short-sighted, with barriers acting to hinder patient and
provider participation that need to be overcome in future PPP plans. There is a need to
consider strategically purchasing primary care services to better allocate existing resources
without relying on a drastic increase in current health expenditures.

Based on the review of recent developments in health financing policies and lessons learnt
from existing initiatives to improve the sustainability of Hong Kong’s health system, we
present a proposal in Chapter 4 that utilises strategic purchasing principles to move
Hong Kong closer to a primary care-led health system. Specifically, we propose a scheme
that aims to encourage the screening and management of prevalent chronic conditions
(specifically hypertension, hyperglycaemia (diabetes), and hyperlipidaemia, collectively
termed HDH). This proposal stands in line with latest Government directions to shift the
health system toward a prevention-based orientation.

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