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“Today’s health services are not fit for 21st century challenges.
Approximately half the world’s population lacks access to essential health care.
Where health care is accessible, it is often fragmented and of poor quality.
The Framework on integrated people-centred health services is a call for a fundamental shift
in the way health services are funded, managed, and delivered.
It supports countries’ progress towards universal health coverage
by shifting away from health systems designed around diseases and health institutions
towards health systems designed for people.” (WHO, 2021c)

5.1 STRATEGIC PURCHASING SHOULD BE

LEVERAGED FOR HONG KONG’S
HEALTH SYSTEM TO BECOME

FIT-FOR-PURPOSE

In the face of a rapidly ageing population, a new normal in Hong Kong continues to reveal a
growing burden of chronic diseases, increasing healthcare costs, and concerns over health
system sustainability. While the Government has committed to transform Hong Kong’s
treatment-oriented health system into one that is prevention-focused and has further
positioned primary healthcare development as a top health policy priority, the supply of
healthcare services in Hong Kong continues to be characterised by the segmentation of the
public and private sectors and fragmented service delivery contributed by underlying
financing mechanisms. The current organisation of health service provision does not
adequately meet emerging population healthcare demands and heavily contributes towards
the biased pattern of behaviour toward overreliance on hospital-centric care particularly in
the more affordable public sector, resulting in health system inefficiencies and continued
fragmentation of our health system. The current organisation also obstructs the realisation of
the World Health Organization (WHO) “health for all” goal which necessitates the
interaction of political will, health sector cooperation, community participation, and
supporting technology to improve health to a level that enables all people to lead socially
rewarding and economically productive lives. Evidently, Hong Kong’s health system is yet to
be fit-for-purpose.

5.1.1 ACHIEVING A FIT-FOR-PURPOSE HEALTH SYSTEM
IN HONG KONG

For Hong Kong’s health system to become fit-for-purpose, we identified in our prior health
policy paper Fit for Purpose: A Health System for the 21st Century a critical goal of
transforming our current system into a “primary care-led, integrated, person-centred health
system”. This will pivot our system away from the current emphasis on hospital-based,
specialist, episodic care towards care in the community that is continuous and person-
centred and is integrated across the different levels of care, coordinated between specialities
and providers, and interfaced with social care. This will also provide the system infrastructure
to meet the holistic needs of individuals and transform the healthcare delivery system into
one that aspires to provide “Health for All” and enhance the effectiveness and efficiency of
the health system. This transformation will require an evaluation of the current gaps in
provision of the different service types and the mechanisms for how these could be better
provided and/or bridged both within and between the public and private sectors. The
delineation of a strategic role for the private sector in the design of a better integrated system
in our segmented public and private healthcare system will be crucial. Leadership in
governance will be of essence and must engage with a shared vision that is supported by
strategic goals to enable policies, and strategic purchasing. Governance structures should
also commission mechanisms and enhance workforce planning to ensure appropriate
education and professional development required for the right mix and competencies of
healthcare professionals.
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