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well-intended but are often narrow in scope in terms of participant eligibility, and unambitious
in provider enrolment and long-term service targets. Hence, despite efforts to position PPPs
as a means of enhancing accessibility to health services in a timelier manner, existing PPPs
have generally been reactive in efforts to bandage over cracks in our health system, without
consideration of the longer-term structural changes necessary to enhance system efficiency
and sustainability. Existing PPPs could thus be better positioned within a strategic approach
in the vision to meet health system goals. In conjunction with the recommendations
presented in our 2018 health policy paper and assessment of primary care services in both
public and private sectors, this report is prefaced on the conviction that the role of PPPs
should be incorporated under a framework for strategic purchasing, which will enable a
better assessment of the gaps in integrated care which should be addressed by
harnessing the capacity of the private sector where most of Hong Kong’s primary care is
currently provided.

5.1.4 STRATEGIC PURCHASING FOR A PRIMARY
CARE-LED INTEGRATED CARE SYSTEM

In the spirit of promoting equity such that health progress is made available to everyone
through better management of available resources, our 2018 health policy paper also
highlighted the importance of strategic resource allocation and the use of
health financing as a lever to propel primary healthcare development to
achieve health system goals. We presented strategic purchasing as an important lever in
health service planning that will contribute to bettering health service quality and system
efficiency while enhancing equity in the allocation of resources that will be distributed to meet
the most pressing demands. Strategic purchasing makes use of available data to inform the
type and mix of services that should be purchased to meet population health needs and the
system goal of a primary care led person centred integrated care system. Doing so
necessitates an ongoing thorough assessment of population needs including the
identification of needs that are unmet. Also necessary is the discernment of service delivery
gaps and mechanisms devised for how they could be better provided or bridged,
consideration of payment methods and assessment of provider performance. Strategic
purchasing can be carried out through either commissioning or contracting, and the usage of
multiple payment methods. Importantly, careful planning and implementation of purchasing
programmes that apply strategic purchasing will facilitate system integration, wherein
the links between primary care in the community, hospital and specialist care, between
medical and social care, as well as interfacing public and private sectors–may be
strengthened. We therefore position strategic purchasing as an important component and
essential implementation tool for strategic planning that needs to be applied in Hong Kong to
achieve defined system objectives, including that of providing person-centred,
integrated care for people throughout the life course beginning from
primary care in community settings.

What does strategic purchasing entail?
To enable a health system application of strategic purchasing in Hong Kong with PPPs as the
purchasing instrument, we conducted our study based on two guiding frameworks for
strategic purchasing: the first outlines the key decisions that must be made in the strategic
purchasing process (Figure 5.2); the second involves five main elements used in conceptual
policy deliberations that must be considered for the implementation of strategic purchasing
(Figure 5.3) (Chapter 2).

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