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1.1 With the objective of promoting detection earlier on in the life course, a chronic
disease screening voucher for HDH screening should target individuals
aged 45 to 54 years, the point at which chronic disease
prevalence increases significantly, at the start of the scheme.
Further consideration in design of the Scheme could be given to whether
participating citizens have already been diagnosed with HDH and whether patients
are already on treatment or not under care. Also, a certain element of flexibility
could be considered on how participants will be phased into the Scheme,
particularly for chronic disease management based on factors including the
gradual build-up of capacity for service provision, the subsidy to be provided for
which groups and the corresponding recurrent resources being secured.

1.2 To facilitate access and incentivise participation in screening, we recommend that
the Scheme fully subsidises all screening services, including future
rescreening.

2. In continuing the conceptualisation of a continuous healthcare service delivery model,
we envision a seamless merging of the demand-side voucher scheme and the supply-
side management programme. Adhering to our goal of identifying high-risk individuals
to prevent and/or delay the onset of chronic conditions and prevent the development of
complications (such as neuropathy, eyesight-threatening retinopathy, and limb
amputation for DM) that may require the use of inpatient care services, we further
recommend differentiating the treatment and re-screening plans for patients identified
to have different risk levels. Also with reference to the “Hong Kong Reference
Framework for Diabetes Care for Adults in Primary Care Settings” and “Hong Kong
Reference Framework for Hypertension Care for Adults in Primary Care Settings”
(Task Force on Conceptual Model and Preventive Protocols et al., 2013), we
recommend the following follow-up screening, treatment and management protocol
(Figure 5.4).

2.1 As a first step of entry into the Scheme, participants will undergo screening for
HDH. Scheme participants will be categorised by diagnosis and will receive
disease management and prevention services that are tailored to their diagnostic
needs. This is especially crucial for individuals deemed “high risk” for HDH, as
they are most likely to progress toward diagnosis of a chronic condition.

2.2 Patients diagnosed as presently without HDH are recommended to receive
care in the private sector for regular screening services and further
lifestyle guidance and advice. We recommend that the Government consider
subsidising one follow-up consultation with the same private sector medical
practitioner, the cost of which is included in our economic analysis. They should
also be referred for regular re-screening preferably with the same
private sector medical practitioner at intervals that are suited to their
health condition.

2.3 Patients diagnosed as “high risk” for future HDH (including those with an
early form of HDH, such as prediabetes, and those without prediabetes but are at
high risk of developing an early form of HDH) are recommended to attend a follow-
up consultation with the same private sector medical practitioner. They should
also be referred for regular re-screening with the same private sector
medical practitioner at intervals that are suited to their health condition.

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