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Public-private mixed system

            Social health insurance and tax-based systems offer viable routes to UHC. However there is
            evidence that a few health systems with modest levels of government spending and that use
            approaches that do not fit the classic tax-based model have been able to progress
            substantially towards UHC. These cases include Sri Lanka, Malaysia, Hong Kong, Ireland,
            and Australia. These health systems combine public financing and delivery with a substantial
            reliance on private financing and delivery. They have been described as dual-track, parallel,
            and hybrid systems to denote their mixed public-private funding and provision approach.
            These systems, which span the globe and levels of economic development, may be
            characterised by notable performance on health outcomes, low levels of government
            spending, and a significant out-of-pocket spending share in total financing.


            2.2.2 INTERNATIONAL COMPARATIVE ANALYSIS:
                    STRATEGIC PURCHASING FOR CHRONIC DISEASE
                    SCREENING AND MANAGEMENT

            Each system has its own merits and limitations and challenges which may be aggravated by
            escalating healthcare demand driven by population ageing and the associated increasing
            prevalence of chronic diseases. Rather than reforming the entire foundation of healthcare
            financing schemes, strategic purchasing allows mobilisation of finite resources to optimise
            provider systems, hence increasing capacity and enabling long-term sustainability.

            To better explore how strategic purchasing works in chronic disease prevention and
            management which is one of the biggest challenges in Hong Kong and globally, we used a
            qualitative case study approach to review the purchasing programmes against a strategic
            purchasing framework. Different jurisdictions were chosen for diverse geographical locations
            and health system types (tax-based system, social health insurance system, private health
            insurance dominated system, and public-private mixed system). The resulting sample was of
            eight jurisdictions: the United Kingdom (UK), Canada, China, Japan, the United States (US),
            Australia, Malaysia, and Singapore. An overview of economic and health spending indicators
            of the jurisdictions is presented in Table 2.1.

            For each jurisdiction, one existing purchasing programme or policy for chronic disease
            prevention and management was reviewed. As presented in the Section 2.1, purchasing
            involves mainly three sets of decisions: (a) what to purchase: identifying the interventions or
            services to be purchased, taking into account population needs, national health priorities,
            cost-effectiveness and other factors; (b) from whom to purchase: choosing service providers,
            giving consideration to service quality, efficiency and equity and (c) how to purchase:
            determining how services will be purchased, including contractual arrangements and
            provider payment mechanisms. The purchasing programme/policy for chronic disease
            screening and management in each jurisdiction was reviewed from those three perspectives
            in Table 2.2.

            The key goal of this section is to evaluate to what extent these purchasing programmes fulfil
            the definition of strategic purchasing. Several theoretical models exist that define strategic
            purchasing. We used the synthesised framework of strategic purchasing constructed by
            Klasa et al., which was derived from systematically reviewing the existing definitions and
            components of strategic purchasing (Klasa et al., 2018). We benchmarked the characteristics
            of those purchasing programmes in Table 2.2 against the synthesised strategic purchasing
            framework.









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