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Element 3:
Strengthen government stewardship & capacity, as indicated by
strong governance

Strong governance is the cornerstone of successful strategic purchasing. The ability to
centralise policies in favour of systemic decision-making by a purchaser will prove critical in
the credibility of the Government and Scheme and to reduce potential fragmentation of an
already fragmented healthcare service structure. The role of the purchaser and the
Government in enforcing fair rules, incentives, and sanctions as tools to facilitate programme
implementation must be strengthened.

1. To centralise the provision of primary care services and to ensure that the Scheme is
effectively implemented, the Government needs to ensure clear role delineation for the
responsibility of purchasing and payment of services.

a. The current major service provider of preventive primary care is the Department of
Health (DH), while the Hospital Authority (HA) provides primary care through
General Out-patient Clinics and Family Medicine Specialist Clinics. As separate
departments, the current provision of primary care is fragmented. Therefore, it is
important that the Government names a central purchaser, organiser
and implementor of the Scheme and other programmes that involves
purchasing health services to avoid intensifying the fragmentation of
primary care provision.

2. The Government should set clear functions for the identified purchaser; including
consideration of the following:

a. Set well-communicated guidelines and standards to ensure
consistency of care between public and private sectors, together with defined
care protocols that will help to overcome professional barriers between the
two sectors.

b. Draft standard treatment guidelines and care protocols that cover
individual needs that are outside of conventional service scopes and benefit
package designs, particularly among patients facing multi-morbidities.

c. Set clear definitions to prevent potential implementation challenges
such as induced moral hazard, a phenomenon wherein healthcare professionals
may ask Scheme participants to pay “additional charges” on top of the subsidised
amount, and provide unnecessary health services to the benefit of health service
providers, leading to unwarranted price inflation (Yeoh et al., 2020).

d. Ensure coordination between existing and future public-private
partnership schemes, in order to prevent further fragmentation of the health
system (WHO, 2017b).

e. Put in place accountability arrangements to align and steer purchasers within the
system towards common health system goals (WHO, 2017b). The purchaser
should establish feedback loops to receive and respond to complaints or
feedback and conduct systematic evaluation regularly.

f. Regularise the release of public reports on the expenditures and
performance of existing PPP programmes and the Scheme upon its
implementation. Such reports will play an important role in determining the budget
required for the improvement of existing PPP programmes and implementation of
the Scheme, which are subject to yearly change in government expenditure.

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