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1.1 HONG KONG’ S HEALTH SYSTEM IS

STILL NOT FIT-FOR-PURPOSE

Box 1.1

What is a “fit-for-purpose health system”?

A fit-for-purpose health system is responsive to a constantly changing health
landscape shaped by demographic, epidemiologic, knowledge, and
technological disruptions. Such a system addresses changing needs across
people’s life course, and it comprises a myriad of functions including
encouraging health promotion and disease prevention at a young age,
advocating for early management of chronic diseases to middle-aged adults,
as well as catering for the diverse needs of our older populations until end
stages of life. It requires that Hong Kong shifts from a treatment-focused and
hospital-centric health system to one that is primary care-led and person-
centred.

Source: OHKF, 2018

Hong Kong has a world-class health system along the measures of life expectancy, neonatal
and maternal mortality, and is one of the world’s most efficient health systems. Residents
enjoyed an average life expectancy at birth of 85.5 years in 2020 (82.9 years for males and
88.0 years for females) (C&SD, 2021a). Using the latest available cross-region health
expenditure statistics, Hong Kong’s current health expenditure in 2018–19 took up only 5.9%
of its GDP, a lower proportion compared to its high-income counterparts as classified by the
World Bank, including the United Kingdom (UK) (10.0%), Japan (11.0%), and Australia (9.0%)
(FHB, 2020a; The World Bank, 2020; WHO, 2021a). Achieving good health outcomes with
relatively low spending on healthcare, Hong Kong was ranked by the Bloomberg Health Care
Efficiency Index in 2020 to be the 2nd most efficient public healthcare system in the world
after accounting for the impact of COVID-19 on mortality (Miller & Lu, 2020). Furthermore, the
local public healthcare system is positioned as a “safety net” for the Hong Kong population,
particularly for individuals challenged with a lack of means to pay for healthcare, as it offers
quality care at the point of service with low healthcare costs and with further subsidies for
vulnerable populations to facilitate healthcare access. Overall, Hong Kong’s health system
has contributed to the population’s long lifespan, with universal access to public services at a
low cost.

Despite Hong Kong’s health system achievements, inequalities in health and access
to healthcare correlated with income disparities persist. While the public
sector functions as a “safety net” with affordable prices, the private sector works as a
supplement by providing choices and faster access of care to people who are willing to and
able to pay for themselves, either by private health insurance, or from out-of-pocket payment.
However, according to the 2021 World Competitiveness Ranking, out of 64 regions, Hong
Kong is ranked among the top one-third regions with the highest wealth disparities indicated
by the Gini coefficient, an indicator of the wealth gap between the rich and the poor (IMD,
2021; OECD, 2002). Such wealth inequalities restrict those with less financial capacity from
accessing quality healthcare in a timely manner; they have the option to seek care in the
public sector, but the public sector’s service capacity is overwhelmed by increasing health
demands, best exemplified by long waiting times for outpatient specialist services common
across specialties and geographical clusters in the Hospital Authority (HA) (Table 1.1). In fact,
approximately 8.4% of a Hong Kong population sample reported that they did not seek
medical care due to lack of financial means in 2017, suggesting that in Hong Kong, persons
19