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Universal health coverage (UHC) is defined by the
WHO as “all people [having] access to the health
services they need, when and where they need
them, without financial hardship.” (WHO, n.d.)

Evidently, providing accessible, affordable and well-integrated primary care that is person-
centred to meet emerging population health needs and in alignment with the goals of
universal health coverage (UHC) remain continuous challenges that must be addressed in
Hong Kong. To overcome these challenges, selecting the right policy tools and levers is key
to successful system transformation to realise set system goals. Financing mechanisms
have been recognised as a key policy lever to implement system-wide
reforms that must be aligned with service delivery goals to facilitate
system change. In progressing towards the provision of person-centred integrated
healthcare, health systems around the world have implemented different financing
mechanisms, such as strategic purchasing and commissioning, and payment tools including
capitation and performance-based payment schemes which consider service provider
incentives and accountability, that are context-specific to meet the unique needs of different
health systems.

Amongst the various health financing strategies and reforms proposed in past decades,
Hong Kong has used PPPs as a purchasing instrument to better leverage existing resources
from both sectors to provide care that meets population demands. Many of the PPP
initiatives have been positioned to tackle pressing demand, are modest in scope and
disease-focused. Focus has also been placed on disease prevention and primary care.
Those aimed to promote primary care uptake, such as the General Outpatient Clinic-PPP
(GOPC-PPP) and the Elderly Health Care Voucher Scheme (EHCVS), have been implemented
as specific programmes and not designed from a systems perspective, and without the
critical emphasis on care integration, they have shown varying degrees of success in
actualising programme goals let alone system goals. Lessons learned from the plethora of
well-intended pilot programmes, one-off projects, and prior consultations for achieving
person-centred integrated care must be leveraged and successful programmes should be
scaled-up in a strategic and coordinated manner. Promoting better care integration calls for a
more strategic approach to commissioning care in the public sector and purchasing care
from the private sector to better cater for total population needs.

In parallel to the building of a primary care ecosystem in the public sector that will take time
and moving beyond injecting additional funds into the health budget, it is our view that
available resources within our current portfolio must be allocated more strategically and be
directed towards prioritised primary care services. Strategic purchasing will be a
critical lever in health system governance and health service planning to
achieve this through enabling better allocation and utilisation of
resources to meet population needs, and the appropriate recalibration of the
public-private mix to improve healthcare delivery effectiveness and efficiency (Box B). Careful
planning and implementation of purchasing initiatives that apply strategic purchasing can
facilitate system integration. The strategic purchasing concept can be applied not just to
facilitate the design of specific healthcare programmes, but also as a critical system-level
policy lever for transforming the health system into one that is primary care-led, integrated
and person-centred. As such, decisions in strategic purchasing must become
an integral function of health system governance, aligned with the strategic
goals and considered in the context of the interconnected objectives of macro, meso and
micro- levels of the health system (Box C).

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