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4) Strategic purchasing as a system level instrument
for the transformation to a primary care-led
integrated person-centred health system

Despite the efforts made by the Government to improve the provision of primary care and
well-integrated care, existing policies and programmes are often immediate interventions and
not positioned to be long-term solutions to address major problems. Our report not only
introduces the strategic purchasing perspective for the design of a PPP programme, but also
recommends and describes how the Government should incorporate strategic
purchasing in health system governance functions and how it can be a
critical lever to transform our health system to be fit-for-purpose. From the
system level, strategic purchasing can inform a broad range of interconnected government
decisions, at the three macro, meso and micro levels. Strategic purchasing decisions of
whom to purchase, who to purchase, and how to purchase can be informed from
assessment of population health needs, identification of gaps in healthcare service types,
assessment of the capacity and capabilities of the public and private sectors. Strategic
purchasing will enable resources to be allocated to where they could be
better utilised to meet system goals and population needs, ensure medical
and social care system to develop in ways which are sustainable by fostering closer
integration, and healthcare development of primary, secondary and
tertiary care coupled with better coordination with social care.

Leveraging the achievements of the current Administration in PHC development and in
anticipation of the city’s Primary Healthcare Blueprint to be presented for public consultation
in the upcoming months (at the time of writing), this policy paper has demonstrated the
accessibility and affordability of primary care can be enhanced through strategically
reorienting our health financing purchasing and commissioning mechanisms to deliver
holistic, person-centred, and integrated care. Our aspiration is our research will pave the way
for discussion surrounding a whole health system approach to maximising health system
performance using the strategic purchasing lever. At stake is not simply a matter of the
number of options that patients have for access to care, but rather a matter of whether
patients can realistically attain timely, accessible, appropriate and quality care, without
financial hardship over a life course, which lies at the heart of the WHO’s universal health
coverage goals. This policy paper demonstrates that population health goals may be
achieved by strategically investing in and purchasing of health services, enabling
Hong Kong’s health system to become fit-for-purpose, and in effect, take a major step
towards health for all.

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