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Published: 04:44, December 29, 2022 | Updated: 13:27, December 30, 2022
How to shape up primary healthcare in Hong Kong
By Ho Lok-sang
Published:04:44, December 29, 2022 Updated:13:27, December 30, 2022 By Ho Lok-sang

Professor Lo Chung-mau, the secretary for health, recently released a Primary Healthcare Blueprint for Hong Kong. Strengthening primary healthcare is clearly the right direction to go. As Lo says, Hong Kong has put too much emphasis on a cure and too little on prevention. This is costly on two counts. First, effective prevention is much more likely to save the patient’s life than a cure and translates to better quality of life for more years; a cure is not only expensive and much less effective, but also may mean lower quality of life that the patient has to endure, and often a shortened life expectancy.

Lo is right in being especially concerned about chronic illnesses. Chronic diseases like diabetes and hypertension take a heavy toll on patients’ health, and during the early phase of the diseases, patients’ functional health is hardly affected. So the affected individuals go on with their daily lives as usual, often continuing with unhealthy lifestyles that aggravate the problems. When they finally notice the symptoms, the problems probably will have developed to an extent that the “stock of health” has eroded and cannot be recovered. The patients have to face more heavy medications and a lowered quality of life. 

Lo says that while a million people are currently taking medications for such diseases, another million have probably not been diagnosed. If patients wait until such complications as stroke, heart disease, or kidney failure appear, patients will need specialized medications that are much more costly. Patients of course also have to endure more suffering. The government has proposed introducing a Chronic Disease Co‑Care Pilot Scheme under which the government would shoulder half the medical bills. Lo expects 200,000 people would join the program in its first year, and that the authorities would expand the program to cover other chronic diseases in the future. He estimates the initiative would end up reducing public healthcare expenditure by 30 percent after 30 years. 

While the idea of putting more emphasis on prevention is good, in the short term it must imply an increase in public spending. There is no way we could shift spending from treatment to prevention as we have to treat patients with existing health problems. This increase in spending, in the light of population aging and the relative neglect of prevention among the population, is well justified. If necessary, we will need to find the resources to fund this additional spending in the short term.

It has been pointed out that the idea of funding half of the medical costs when patients visit private clinics under the Chronic Disease Co‑Care Pilot Scheme is unrealistic. Given the fact that the service fees charged by doctors vary significantly, “funding half” means that the government would pay doctors that charge high fees a lot more than those that charge low fees. In principle, qualified doctors should get the same fee from the government for the same service. The government, moreover, should require participating doctors to submit their fees net of the subsidy to the government which will then announce the fees on its website. Doctors should also provide a clear sign at the clinic stating that it participates in the government program and how much it charges to patients in consultation fees. Drugs dispensed should be charged at cost. 

I would propose that the government invite qualified medical practitioners to join the primary care network of government. These would be called Enrolled Primary Care Family Doctors and they would receive a fixed consultation fee from the government. Again, these doctors would need to display their net fees charged to patients clearly at the clinic. The fees should be adjusted no more than once a year and all adjustments should be communicated to the government and posted on its website for transparency. 

The government would keep a record of all clinic visits by every patient. Following Lo’s suggestion that the government should cover half of the consultation charges, I recommend that the basic fees that patients have to pay are equal to the direct fees paid by the government to the doctors. I propose that the government adopt the “excessive burden protection” that I have recommended, that is, cover the excess of the year’s total basic fee payments over a stipulated yearly limit of, say, HK$10,000 ($1,283). This means that if patients only visit doctors who charge the basic fees, then the most they will pay per year is HK$10,000.

The yearly spending limit should also apply to other eligible medical expenses. Currently Hong Kong people other than schoolchildren do not enjoy any dental benefits. I recommend that the government extend dental benefits to the general public, using the same approach of offering half the full basic fees. The other half, to be paid by patients, should add to eligible healthcare expenses paid. If total eligible expenses add to over HK$10,000 in a year, then the government should pay the excess for that year. 

Proper dental care is very important to people’s subjective well-being. Today, many people cannot afford proper dental care. As a result, many people by the age of 70 have hardly any teeth left. Extending basic healthcare to cover dental care in our primary healthcare system will greatly enhance Hong Kong people’s well-being.

The author is the director of the Pan Sutong Shanghai-Hong Kong Economic Policy Research Institute, Lingnan University.

The views do not necessarily reflect those of China Daily.

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