Page 5 - 20211214_OHKF_Health_Finance_Research_Report_E (1)

The World Health Organization (WHO)’s “Health for All” goal necessitates the
interaction of political will, health sector cooperation, community participation
and supporting technology to improve health to a level that enables all people
to lead socially rewarding and economically productive lives (WHO, 1988).

The provision of person-centred integrated care necessitates concerted development of the
local health system through an evaluation of current gaps in the provision and mix of different
service types and the leveraging of mechanisms for how these could be better provided and/
or bridged. Governance leadership will be important to achieve strategic integration
throughout the system, engaging with a shared vision and supported by clear strategic goals
set based on population health needs and service delivery assessment. Enabling policies,
strategic purchasing and commissioning mechanisms together with enhanced workforce
planning to ensure the appropriate education and professional development required for the
right mix and competencies of healthcare professionals is also necessary.

Health system planning and policy formulation in Hong Kong has taken initial strides at
improving coordination to realise person-centred integrated care, where the investment of
resources is not only on hospital and specialist care, but also on building a community-
centric PHC ecosystem. In recent years, the Hong Kong SAR Government (HKSARG, or
referred to as the Government) has committed to transforming Hong Kong’s treatment-
oriented health system into one that is prevention-focused to meet emerging population
health needs and has placed heavy emphasis on PHC development. The gradual
territory-wide rollout of District Health Centres (DHCs) and the mapping of a PHC blueprint
which is anticipated to be presented for public consultation in the upcoming months (at the
time of writing) showcase nascent efforts to propel PHC development in Hong Kong.

Policymaking for integrated care, however, is not an exclusive domain of government, but
instead necessitates cross-sector and multidisciplinary coordination. Joint planning with key
stakeholders across sectors and at different levels of the health system, which includes goal
setting, strategic planning and collective decision making, is necessary for achieving health
system goals. Especially in tackling segmentation between the public and
private healthcare systems in Hong Kong, identified service gaps should
be bridged within and between the public and private sectors. This involves
the delineation of a strategic and complementary role for the private sector in the design of a
better integrated system.

While past policy plans have emphasised the need to better leverage the private sector to
play a complementary role in achieving health system aims, despite the many public-private
partnership (PPP) (Box B) initiatives, the public and private sectors continue to be segmented
in terms of service provision and underlying financing mechanisms. As a result, the supply
of public healthcare services still does not meet population demands
arising from emerging healthcare needs for the prevention and management of chronic
health conditions that necessitates integrated care, particularly at the primary care level. In
contrast with the private sector which provides the bulk of primary care services
(approximately 70%), primary care provision in the public sector is constrained. Primary care
services thus predominantly necessitate out-of-pocket payments (OOPs) and remain
unaffordable to vulnerable populations and the less well-off. Without better leveraging private
sector capacity while improving primary care accessibility, Hong Kong’s health financing
system may contribute to further health system fragmentation.

3