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3.2 Citizen empowerment

The strategic purchasing framework advocates that government and purchasers should
ensure that citizens’ and patients’ values, views, and choices are accounted for. Citizens
should be allowed input on their benefit package, their choice of provider, and ability to hold
purchasers and providers accountable for services offered. Therefore, new programmes
need to consider the most relevant needs of citizens that should be solicited from the
adoption of a citizen-participatory design process. At the same time, purchasers’
accountability should be strengthened to enhance citizen and patient empowerment.

As an example, screening programmes are more likely to be more successful if no
co-payments are involved. And so, we propose the screening voucher to fully
subsidise all initial screening and re-screening services while
co-payments for management could be considered based on users’
capacity and willingness-to-pay (WTP). Our population-based survey results
suggest that the WTP for managing chronic conditions ranges from HKD 51 to HKD 200 per
consultation, with lower monthly household income being significantly associated with lower
WTP ranges. This phenomenon should be considered in the programme design process
where the Government can involve patients in devising a co-payment schedule for disease
management.

3.3 Strengthening government stewardship and capacity

To build an effective strategic purchasing system, the regulation and monitoring of
purchasers and providers to ensure that they are meeting agreed objectives is key. Health
systems should adopt an integrated framework that defines explicit contractual terms, and
government capacity to monitor, evaluate and ensure purchasing arrangements are enabling
achievement of health system goals. To achieve this, the Government’s capacity to
monitor the performance of primary care PPP providers must be
enhanced in a regulatory framework. At the same time, the Government needs to
identify a purchaser whose role in purchasing and payment of services is
clearly delineated and defined.

The ability to centralise policies in favour of systemic decision-making by a purchaser proves
critical in the strategic purchasing process applied to the implementation of the proposed
Scheme. We recommend that the purchaser ensures coordination between
existing and future PPPs to advance health system goals, regularly
releases public reports on the expenditures and performance of existing
PPP programmes, as well as of the Scheme upon its implementation.

3.4 Developing effective purchaser and provider organisations

Continuous shifts in needs, demands, funding priorities, treatment options, medicines, and
individual and provider behaviours need to be anticipated in the strategic purchasing
process. This necessitates strategic purchasing agencies to respond to changing contexts
and dynamics of the health system promptly and appropriately to manage the alignment and
dynamics of various changing factors. The expectations for each participating stakeholder
and alignment with health system goals should be made explicit.

As an example, the Government should assess and enhance the capacity
and capability of the health system to match the new service demands
generated by the Scheme and ensure that there is alignment between the
purchaser, providers, and multiple stakeholders. As increased screening
demand and need for chronic disease management will create additional strain on the health
system, we recommend the purchaser to conduct a pre-implementation assessment of
private sector capacity to better inform the design of care guidelines, sufficient levels of
incentives, and referral protocols that are aligned between participating stakeholders. On the

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