10 Health Care System


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
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
  • 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
  • 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
  • Competing resources
  • Different visions, expectations and perspectives
  • 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





Tasks & Worksheets

Coming Soon

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?