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To promote holistic person-centred care that is integrated across the life course, purchasing
instruments such as capitation payment and personal health budget allocations that
necessitate dynamic evaluation and adjustment should be considered. Purchasing contracts
and agreements should build in clauses that incentivise performance promoting person-
centred care. Monitoring and evaluation tools need to consider patient care experience,
satisfaction and patient-reported outcomes. Patient feedback systems should be in place
and considered in the performance monitoring process.

Strategic purchasing is a key health system policy tool that will enable individuals to
experience holistic person-centred care throughout an integrated care journey over the
life course. It will thus be important for the strategic purchasing process to incorporate
a bottom-up perspective that accounts for the needs and wants of system end-users
that in turn, should act to link the micro-, meso- and macro- health system levels for the
delivery of person-centred integrated care.

CONCLUSION

Our 2018 policy paper Fit for Purpose: A Health System for the 21st Century recommended
system-level transformations that would best equip Hong Kong’s health system for meeting
21st century population health challenges. In moving towards the visionary health system
presented in our paper that is primary care-led, integrated and person-centred, we
highlighted that “strategically purchasing services, allocating resources appropriately and
utilising purchasing and payment mechanisms can enable coordination and integration
between service providers.”

The present report elaborates on strategic purchasing and puts forward that beyond
facilitating the design of specific healthcare programmes, strategic purchasing serves as a
critical policy lever for health system transformation to achieve a person-centred, integrated
care system. We presented a framework that illustrates how the decisions in strategic
purchasing should be considered in the context of the interconnected objectives and goals
at all three levels of the health system, including macro- (health system), meso- (healthcare
delivery purchaser-provider system), and micro- (person journey of healthcare delivery) levels
to achieve better integration across preventive, curative, rehabilitative, palliative and social
care provided by multidisciplinary teams.

This report also showcases a specific application of strategic purchasing for better integrated
primary care in Hong Kong’s pluralistic health system to meet system goals and population
needs. We demonstrated the application of strategic purchasing to primary care services
that align with system-wide efforts to tackle a key population health challenge, namely the
growing burden of chronic conditions. We also explored the potential for leveraging capacity
of the private sector through PPPs as a purchasing instrument for integrated products of
partnership between the public and private healthcare systems. Specifically, we evaluated
the feasibility of a proposed Chronic Disease Screening Voucher and
Management Scheme designed based on strategic purchasing criteria that will enhance
accessibility of both chronic disease screening and management, incentivise the uptake of
primary care services in a targeted manner, and leverage private sector capacity to
complement the public sector.

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