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The previous chapters have established strategic purchasing as an effective health financing
lever that facilitates progress towards achieving universal health coverage. In Hong Kong
where the health system is making important strides forward in primary healthcare (PHC)
development, strategic purchasing can be applied to better leverage existing resources for
improving primary care accessibility continuity, affordability, and uptake in advancing to a
fit-for-purpose health system. In particular, the characteristic segmentation between public
and private sectors means that strategic purchasing can be applied to better leverage private
sector capacity for it to play a complementary role in achieving health system goals. In this
chapter, we assess the feasibility of applying strategic purchasing as a
governance tool propel PHC development in Hong Kong.

An important aspect of PHC is the role in early detection of disease enabling timely quality
care to delay disease progression, and allows for earlier disease management to prevent
complications that may reduce hospital care burden and costs in the long-run (Box 4.1).
While government-initiated population screening programmes currently exist, such as the
Colorectal Cancer Screening Programme and the Community Care Fund Pilot Scheme on
Subsidised Cervical Cancer Screening and Preventive Education for Eligible Low-Income
Women, these programmes are primarily cancer-focused with suboptimal uptake rates,
and are generally not designed to detect prevalent chronic conditions, such as high blood
pressure, high blood glucose, and high blood lipid levels.

Box 4.1

Disease screening and its benefits

Screening is a key mechanism for controlling and stymying the burgeoning
chronic disease burden. Screening typically is a means of detecting
disease at earlier stages, providing patients more time to
delay or even prevent its onset, and opening more options to
patients for treatment and management of their condition
(Lee et al., 2016). Management of chronic disease may aid in preventing the
escalation of symptoms, thereby reducing the likelihood of requiring more
invasive medical procedures to maintain a steady level of health. Thus, health
system planners must proactively improve its prevention and management
efforts for building long-term health to stem the manifestation and growth of
chronic diseases.

Screening can provide long-term economic savings and
health benefits (Kaczorowski et al., 2011; Strong et al., 2016; Zelen &
Feinleib, 1969). By delaying the development of multi-morbidities and
complications associated with chronic diseases, the direct costs of hospital
utilisation, accident and emergency (A&E) visits, and out-of-pocket payments
(OOPs) can be reduced (Sambamoorthi et al., 2015). In fact, several studies
have demonstrated a positive relationship between health expenditure and
instances of multi-morbidity due to chronic disease interaction. For instance,
the cost of care skyrockets due to the increase in usage of polypharmacy
(multiple medications) in which adverse drug events can render significant
costs to the health system (Lehnert et al., 2011).

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