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Our population-based telephone survey showed that
75.3% of respondents were willing to join the Scheme.

Economic analysis suggests that the health system will
spend approximately 28% less on direct healthcare
expenses over 30 years upon the implementation of a
screening voucher and management scheme for diabetes.

RECOMMENDATION 2. Hong Kong should introduce a
Chronic Disease Screening Voucher and Management
Scheme to enhance primary care accessibility

As an illustration of the application of strategic purchasing in the Hong Kong context, we
propose the introduction of a scheme that targets chronic disease prevention and
management and leverages private sector capacity. By focusing on early detection of
disease through screening and well-thought-out management services in community
settings, the Scheme is designed to alleviate pressure on public hospitals and curb
healthcare costs associated with preventable chronic disease complications. Our demonstration
hopes to pave way for the discussion of the strategic purchasing lever as part of a whole
health system approach in maximising health system performance by better strategically
prioritising what services to purchase, who should purchase, for whom, from whom, and how.

• What services to purchase? We propose that HDH screening, re-screening, and
follow-up management services and associated medications in the private
sector, as well as management services for adults diagnosed with
conditions co-morbid with HDH in the private sector to be purchased. To facilitate
access and incentivise participation in screening, we recommend that the Scheme
fully subsidises all screening services, including future rescreening.
To prevent and/or delay the onset of chronic conditions, and prevent the development of
complications, we further recommend differentiating the treatment and re-screening plans for
patients identified to have different risk levels. Among patients who have been diagnosed
with HDH, we recommend the use of the Risk Assessment Management
Programme (RAMP) risk-level assessment for the formulation of a
personalised care plan with the potential of care subsidisation for chronic
disease management. In our analysis on the impact of the Scheme for DM only, the
annual cost to the system associated with the management of patients diagnosed with DM
without complications and necessitate basic outpatient follow-up care (such as medication
refills, lifestyle modification consultations) has been projected to range from HKD 5,950 to
HKD 15,383 per patient per year on average, depending on age group (with higher costs in
older age groups) (Jiao et al., 2017). While screening services in our Scheme are without cost
to the end-user, the Government needs to study the potential to subsidise or create
a co-payment schedule for populations that face financial difficulties to support chronic
disease management, for instance those with an income below 60% of the Median Monthly
Domestic Household Income. The projected cost for chronic disease management of
diagnosed patients with comorbidities associated with DM and related complications that
necessitate inpatient care stands at HKD 123,364 per patient per year in direct costs to the
health system (according to our suggested care protocol, these patients will be referred to
public hospitals for follow-up management) (Jiao et al., 2018).

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