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