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While the public and private sectors traditionally work separately of each other, patients
oftentimes utilise both sectors simultaneously. For instance, as exemplified among older
patients without chronic diseases, a majority of these patients opt for outpatient care in the
private sector and approximately 12% turn to dual usage of public and private services. In
contrast, nearly half of older patients with at least one chronic disease will use both public
and private services for outpatient management of their chronic conditions that necessitate
long term care (Figure 1.11) (Yeoh, 2020). This suggests that the inadequate public provision
of primary care and the public-private segmentation in the health system contribute to the
dual use of both sectors, particularly for patients with chronic diseases, which leads to
discontinuity of care for complex patient needs and contributes to inefficiencies in healthcare
delivery.

Figure 1.11
Patterns of outpatient-care-seeking amongst the older population
(aged 65 and above) in Hong Kong

Hong Kong Elderly 65+

Outpatient Inpatient
Public Private
No chronic (24.3%) (56.5%) Private
diseases Public (0.6%)
Both (11.7%) (2.9%)

Private
Public (59.0%)
At least 1 (81.6%) Public
chronic (13.7%)
disease Private
Both (44.7%) (1.7%)

[1]
Approaching Most cannot go for outpatient due to Public Private/homes
end of life physical problem or transportation (82.9%) (17.1%)

Note: [1] percentage includes all deaths aged 65+ outside public hospitals
Sources: C&SD, 2011; Yeoh, 2018b, 2020

Underdeveloped primary healthcare

Hong Kong’s underdeveloped primary healthcare system contributes to the perpetuation of
the current hospital-centric model. According to a study based on patients admitted to
public hospitals in 2007, nearly half of older populations’ hospital admissions in the public
sector could be avoided if more appropriate, timely, and effective primary care had been
provided to older patients post-discharge (Yam et al., 2014). Health promotion, prevention of
chronic diseases as well as disease management remain inadequate within the public sector,
as highlighted by the predominantly specialist and hospital service provision model in the
public sector (Figure 1.10). As a result, low-income patients are given few options for
preventing and managing chronic conditions. Long waiting times for specialist care delay
treatment and diagnoses, which potentially induces further health complications that require
costly tertiary care. Therefore, Hong Kong’s PHC system must be strengthened, with
emphasis on health promotion, disease prevention, and chronic disease management,
instead of having all patients gravitate towards hospitals and specialists regardless of
healthcare needs (OHKF, 2018).

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