Page 203 - 20211214_OHKF_Health_Finance_Research_Report_E (1)

Strategic purchasing for primary care

Leveraging the commitment of the Government in improving population health outcomes
through advancing PHC development and the opportunities to be presented by the Primary
Healthcare Blueprint, this report explored the role of strategic purchasing in accelerating
PHC development in Hong Kong. The Government has positioned primary care as a
top priority on the health policy agenda, both as a sustainability factor
and as a health improvement effort. A local study showed that every HKD 1
invested into homecare for community-dwelling older populations would result in savings
ranging from HKD 9 to HKD 69 from acute care (Leung, 2019). Investments in primary care
can incur cost-savings, and there is a need to decrease the service demand for hospital and
specialist care from the morbidity of chronic disease. A population screening programme for
chronic disease followed by chronic disease management is thus well-positioned to be a
logical choice for purchase. How such services can be efficiently and effectively delivered
within community settings should be also considered.

Strategic purchasing is not only a purchasing approach, but also an important policy lever
that facilitates integrated care. To showcase the potential of strategic purchasing in the Hong
Kong context, this report investigated the application of strategic purchasing towards primary
care services that align with system-wide efforts to tackle a key population health challenge,
namely the growing burden of chronic conditions. Specifically, we illustrate how strategic
purchasing could be applied to screening for chronic disease to enable early management to
prevent morbidity in the private sector. Our research identified the need to improve efforts in
“buying” primary care services as an integrated product in partnerships between the public
and private sectors. Our demonstration will provide insights in future programmes of strategic
purchasing which tackle key health system gaps and address health system inefficiencies.

5.2 HONG KONG SHOULD INTRODUCE A

CHRONIC DISEASE SCREENING

VOUCHER AND MANAGEMENT SCHEME
TO ENHANCE PRIMARY CARE
ACCESSIBILITY

We investigated the potential to apply strategic purchasing with PPPs as a purchasing
instrument in promoting primary care utilisation and access, as an initial step for health
system transformation in Hong Kong. In particular, given the urgent need for Hong Kong’s
health system to address the growing burden of chronic disease that in many cases are
preventable and necessitate continuous management, we assessed the feasibility of
introducing a Chronic Disease Screening Voucher and Management Scheme
(CDSVMS, also addressed as “Scheme”) to incentivise citizens to engage in early detection
and intervention of prevalent chronic diseases. Importantly, we intend for the Scheme to
alleviate pressure on public hospitals, curb healthcare costs associated with chronic disease
complications, and leverage private sector capacity to increase primary care accessibility
and coverage. In practice, the Scheme will offer a voucher that fully subsidises
screening for three targeted chronic conditions–hypertension,
hyperlipidaemia, hyperglycaemia (collectively termed “HDH”, hypertension-diabetes-
hyperlipidaemia) coupled with follow-up management plans in the private sector. We
reference international examples of national-level strategic purchasing strategies for chronic
disease screening and management services (Chapter 2) and existing efforts to encourage
primary care uptake in Hong Kong to inform the design of the Scheme, summarised in
Box 5.1 in accordance with Framework 1 (Figure 5.2).

201