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Recent progress made to actualise our visionary primary care-led health system includes the
setting up of the Steering Committee on Primary Healthcare Development
in 2017, which informs the direction for Hong Kong’s PHC development, and the much
anticipated primary healthcare blueprint which is to be presented for public
consultation in the upcoming months (at the time of writing). It is thus timely and important
for efforts to be accelerated in transforming our health system to provide accessible,
affordable, and person-centred primary care in order to actualise the Government’s
undertaking to “protect and promote public health, provide lifelong holistic health care to
every citizen of Hong Kong, and ensure that no one is denied adequate medical treatment
due to lack of means” (HKSARG, n.d.-b).

1.2 THIS REPORT

This report builds on the research presented in our previous policy reports and is integral to
ongoing advocacy to transform our healthcare system into a primary care-led health system
in Hong Kong. In this report, Our Hong Kong Foundation together with Professor Yeoh
Eng-kiong and his team in the Centre for Health Systems and Policy Research of The Jockey
Club School of Public Health and Primary Care, Faculty of Medicine, the Chinese University
of Hong Kong (CUHK-JCSPHPC) investigates health financing levers applicable to
the local context where provision of primary care is inadequate in the
public sector and unaffordable to many in the private sector. Specifically,
key areas of investigation include Hong Kong’s potential in application of strategic purchasing
and the potential for leveraging public-private partnerships (PPPs), particularly for primary
care services, so that every resident can receive the pledged quality care in an affordable
and timely manner.

International evidence shows that a greater reliance on public funding sources within the
health system improves access to health services and provides greater financial protection
for the population at large. Throughout this report, we look at evidence from various health
systems to gain insight on the application of strategic purchasing for chronic disease
prevention and management and best practices for strategic purchasing designs. We explore
how capacity in the private sector can be better leveraged for primary care provision through
Public-Private Partnerships in Hong Kong, while also creating a better reliance on public
funding, for the financing of primary care services and in accelerating its development.
Specifically, we examine both supply-side and demand-side incentives and assess the
feasibility of a proposed Chronic Disease Screening Voucher and Management
Scheme (CDSVMS, also addressed as “Scheme”) that utilises a voucher PPP
model.

In our study which has received funding support from the Public Policy Research
Funding Scheme of the Policy Innovation and Co-ordination Office of the
HKSARG (Project number: 2020.A4.068.20B), we conducted an in-depth examination of
healthcare vouchers as a demand-side incentive and assessed the feasibility of the proposed
Scheme targeted at a better-defined population and scope of services. We emphasised the
importance of not just investing in preventive measures such as chronic disease screening,
but also of investing in follow-up care and chronic disease management which may be
needed. Specifically, the proposed Scheme is set out to remove financial disincentives for
population screening for prevalent chronic conditions including hypertension, hyperglycaemia
(diabetes), and hyperlipidaemia (termed collectively as HDH) targeted at the general
population aged 45 years or above. We also presented proposals for subsequent chronic
disease management care pathways. The proposed Scheme aims to better leverage existing
resources to improve primary care accessibility, affordability, and uptake. Potential
enhancements that could be made using strategic purchasing as a lever within the
current segmented system of public and private financing with reference to evaluations of
local experience and international best practices will be discussed.

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