10 Health Care System
Highlights:
1. Primary care
Primary health care
- health promotion, illness prevention, care of the sick, advocacy and community development
Primary medical care
- a component of primary health care which is the health services provided by qualified health professionals such as family doctors
2. Three levels of medical care
Primary medical care
- first point of contact that patients make with their doctors
- such as general practitioners
Secondary medical care
- specialist medical care
- hospital care – in patient care, day surgery, specialist out patient, and Accident and Emergency services
Tertiary medical care
- highly complex and costly hospital care
- such as organ transplants and radio-surgery of the brain
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3. Healthcare System in Hong Kong
Policy Objective：
to ensure no one is deprived of medical care because of lack of means
Food and Health Bureau
- Policy Making
Hospital Authority
- management of public hospitals, specialist clinics and related outreaching services
Department of Health
- promotive, preventive, curative and rehabilitative services
4. Public and Private Sectors and their Roles in Healthcare Services
Public Sector
- predominant provider of secondary and tertiary healthcare services
- provides Hong Kong citizens with equitable access to healthcare service at highly subsidized rates
- a safety net for all with four areas of services:
- Acute and emergency care
- lower-income and under-privileged groups
- Illnesses that entail cost, advanced technology and multi-disciplinary professional team work
- Training of healthcare professionals
Private Sector
- main provider of primary care
- complements public healthcare by offering choice for those who can afford and are willing to use private healthcare services
- offers personalised choices, enhanced privacy and more accessible services
5. Burden of Public Sector: Adjusting the balance between Public and Private Sectors
Reasons
- Ageing population leads to an increasing need on secondary / tertiary medical care , i.e. expanding healthcare expenditure in public sector
- Public sector cannot meet the needs by an increased deployment of human resources in short term
- Workload of medical and health professionals in the public sector is heavy
- Waiting lists and waiting time on the treatment for chronic illnesses in public sector becomes longer and longer
Ways to adjust
- Strengthen Public Safety Net – deploy more manpower and resources in public sector
- Review Healthcare Manpower Planning – Increase the training
- Enhance Primary Care
- Promote Public-Private Partnership
- Voluntary Health Insurance Scheme
- Review Regulation of Private Healthcare Facilities
- Develop Electronic Health Record Sharing
6. Public-private collaboration
Forms of public-private collaboration
- subsidy of the services provided by private sector makes it affordable to those patients willing to pay
- shared care
Benefits
- control of the expanding cost: from being the major service provider to subsidizing the services with cost controlled
- participation of private medical and health professionals instantly provide more human resources for the treatment or patients
- extends patients’ choice – private medical practitioners may be located in areas convenient and may be available during more convenient time for the service users
- some patients may choose services provided by private sector to reduce the waiting time
- encourages higher income segments of the population to use the services provided by the private sector
- the waiting list for the treatment in public sector will be shortened as some of the patients my
choose services provided by private sector
7. Tension and crisis
Tension
- Competing resources
- Different visions, expectations and perspectives
Crisis
- Quality of services decline/ malpractice
- Ineffective use of resources
- Obstruct the coordinated service delivery that best fit the clients
- Health services become fragmented, poorly planned and badly coordinated
- If services are confined to the same standard, hamper the development of the private sector
8. Health Care Systems in Different Countries
Market-oriented countries
- Rationale
- Individual needs should be satisfied by the private market and family
- Allocation of resources according to consumers’ willingness to pay
- Policy objectives
- To minimize government intervention. Government only provides assistance through Medicaid and Medicare to the low-income individuals and families
- Feature of service provision
- Private Insurance, supplemented by government aid (Medicaid and Medicare in USA)
- Example : USA
Welfare states
- Rationale
- Everyone is entitled to reasonable access to health care, regardless of the ability to pay
- Policy objectives
- To provide universal services for all people
- To provide access to a comprehensive range of health services
- Feature of service provision
- Public hospital services – free of charge for all citizens/ Fully subsidized primary health care services/ Medicine to be paid at a flat rate for each prescription
- Example : UK, Canada
Latest Update: October 2019
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Assessing my learning
- What is health care?
- What are the major features of healthcare system in Hong Kong?
- Why does the existing healthcare system need to be reformed?