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c. Primary care professionals–in both public and private sectors–must be equipped
to educate the public on the importance of engaging in regular preventive
behaviours and to work towards increasing population health literacy, which our
study identified as a determinant of willingness to screen.

d. In accordance with our previous recommendation to recruit allied health
professionals to conduct the risk assessments using current RAMP protocols and
to provide further patient-specific management advice, the Government should
consider enhancing allied health professional training and incentives for their
participation and review the existing supply of allied health professionals.

e. The Government and purchaser should strengthen efforts toward increasing
accountability between purchasers, providers, and patients to ensure that health
system and population health goals are met. To do so, the responsibilities and
roles of each stakeholder should be made explicit and disseminated widely.

2. To ensure health system alignment towards shared health system goals and a visionary
primary care-led reorientation, the Government should ensure that the Scheme is well-
integrated with and supplements ongoing primary care initiatives such as the EHCVS
and services provided by District Health Centres (DHC), and that it will facilitate the
establishment of a solid primary healthcare ecosystem for Hong Kong together with
other ongoing initiatives.

a. The EHCVS can reference to the design of the Scheme that promotes uptake of
targeted primary care services. For instance, the Government can consider
allocating a portion of the subsidy offered in the EHCVS to fund specified
screening services and also explore contracting mechanisms with private sector
primary care service providers for the provision of subsidised chronic disease
management. Furthermore, the purchaser could consider making efforts towards
aligning the Scheme with the EHCVS, whereby individuals participating in the
Scheme can continue to receive similar services upon reaching the age of
eligibility for the EHCVS (65 years and above), and thus be part of both
programmes. While the target populations for both programmes do not overlap,
it is necessary to ensure the continuity in access across the life course.

b. The setting up of DHCs is a major initiative for PHC development in Hong Kong,
hence the manner in which DHC services can be leveraged to complement
implementation of the Scheme should be studied and defined. For example,
chronic disease risk assessment and management is within the service profile of
DHCs, although risk assessment, diagnosis and management services remain
fragmented between DHCs and network service providers. This discourages
continuity in primary care that necessitates patient affiliation with a primary care
doctor. In contrast, the proposed Scheme encourages continuity in
primary care where screening, diagnosis and management is
overseen by the same primary care physician in the private
sector. With preventive care being a key element of DHCs’ service profile,
leveraging the role of DHCs for the provision of upstream
preventive care should be considered by the Government. As an
example, the purchaser can set up a collaborative agreement with DHCs wherein
DHCs focus on preventive services that serve to prevent or delay the onset of
diabetes among populations that are not diagnosed with HDH, especially those at
a high risk of HDH development. In alignment with recommendations presented in
our 2018 report, we recommend that as a “primary care hub”, DHCs should strive
to fully leverage their networks to join the Scheme as providers of lifestyle
modification guidance and other patient empowerment activities.

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