An issue of great concern is whether Hong Kong’s medical and financial resources could be stretched to the maximum extent to maintain an over-burdened treatment-oriented and hospital-based healthcare system in the long run. Disappointingly, the answer is no. In order to make our healthcare system sustainable, we must ease the excessive burden on the hospital-based public healthcare system. It is an unassailable fact that a primary healthcare system offers a way out of the impasse.
In his 2022 Policy Address, Chief Executive John Lee Ka-chiu took an important step in the right direction by providing a medical roadmap showing how the promotion of primary healthcare could make Hong Kong’s healthcare system more sustainable. Primary healthcare is the first point of contact for individuals and families in a continuous healthcare process in the community, which entails the provision of accessible, comprehensive, continuing, coordinated and person-centered care. It serves as a gateway to specialized secondary and tertiary healthcare in hospital and institution settings (Primary Healthcare Blueprint, Health Bureau, December 2022).
Back in 1990, the Working Party on Primary Healthcare published a report with 102 recommendations. One of the recommendations was the establishment of a statutory primary healthcare authority to oversee the provision of primary healthcare in Hong Kong (Medical and Health, by Leung Man-fu, in The Other Hong Kong Report, Choi Po-king and Ho Lok-sang (eds.) (HK: Chinese University Press, 1993)). But this recommendation has been left on the shelf for many years. The long waiting game will soon come to an end with the establishment of the Primary Healthcare Commission next year (Establishment of the Primary Healthcare Commission, by F.C. Pang and S.S. Lai, in Hong Kong Medical Journal).
Although most of the recommendations of the working party have been relegated to the backburner, the Hong Kong Special Administrative Region government has not turned a blind eye to primary healthcare. In March 2008, what was then termed the Food and Health Bureau published a consultation paper on primary healthcare. In response to the consultation paper, Sian Griffiths and Jeff Lee have drawn attention to the established mainstream view in the medical world that a modern healthcare system needs to be based on primary healthcare (Sian Griffiths and Jeff P.M. Lee, Developing Primary Healthcare in Hong Kong: Evidence into Practice and the Development of Reference Frameworks, in Hong Kong Medical Journal).
It’s worth noting that Our Hong Kong Foundation also supports the need to build a primary healthcare system. In its 2018 report, the foundation noted that over half of people in hospitals suffered from problems that could be dealt with in community clinics (Fit for Purpose: A Healthy System for the 21st Century, in Our Hong Kong Foundation). Therefore, public health functions of health protection, health promotion, disease prevention, surveillance and response, and emergency preparedness need to be integrated with primary and specialist care (ibid).
In order to make our healthcare system sustainable, we must ease the excessive burden on the hospital-based public healthcare system
Financially speaking, public spending on healthcare will increase rapidly in the future not because of rising population numbers but because of aging. One study estimates that it was 8.5 times more expensive to treat those aged 75 or over than to treat those aged 15-64 (Fixing Inequality in Hong Kong, by Richard Wong (HKU Press, 2017)). From a manpower perspective, public expenditure on healthcare should not be cut because it is an indirect investment in human capital and labor productivity.
The over-reliance on a hospital-based healthcare system has resulted in inadequate public expenditure on primary healthcare services. As evidenced by Hong Kong’s Domestic Health Accounts in 2019-20, only around 17 percent of the total public current health expenditure was spent on primary healthcare, with the remaining 83 percent spent on secondary and tertiary healthcare services (F. C. Pang and S. S. Lai, ibid). As Pamela Tin correctly pointed out, during the fifth wave of the COVID-19 pandemic, the hospital-centric system struggled to meet the demands of non-COVID-19-related care despite service availability in the private sector (Better Primary Healthcare Needed During and Beyond the Pandemic, by Pamela Tin, in Our Hong Kong Foundation).
Tin also argues that a stronger primary healthcare ecosystem could have pushed for quicker vaccination uptake and education during the pandemic. Because of the weak primary healthcare system in the city, many old people remained unvaccinated. If the vaccination rate had increased, the COVID-19 death rate would have been reduced. As a result, we should strengthen the primary healthcare system in order to enhance our disease prevention capability.
Recently, the death of two intellectually disabled brothers in Sau Mau Ping Estate has further prompted calls for better community services. Another tragedy occurred in a private flat in Happy Valley in June 2023. Firefighters found an extremely weak and dehydrated 75-year-old woman in her flat. Her younger brother and carer, 71, was found dead in the bedroom. Perhaps District Health Centers should play a greater role in monitoring these hidden patients.
When Secretary for Health Professor Lo Chung-mau introduced the Primary Healthcare Blueprint in late 2022, he focused on prevention and early detection and diagnosis. The major directions of primary healthcare reform include developing a community-based primary healthcare system to further develop the district-based, family-centric community healthcare system based on the service model of district health centers as well as strengthening the concept of “family doctor for all”.
Some of the recommendations of the Primary Healthcare Blueprint include establishing a two-way referral mechanism between primary healthcare services and specialist and hospital services; adopting the co-payment principle in providing government-subsidized primary healthcare programs; reinforcing primary healthcare manpower; and improving data connectivity and health surveillance. There is not the slightest shadow of doubt that the government has strong determination to put the above recommendations into practice. As an indication of its determination, the Chronic Disease Co-Care Pilot Scheme will be introduced in November 2023 to take preventive measures to combat chronic disease.
Zorina Kwong, formerly a registered nurse, is the community pro-bono services senior adviser of Chinese Dream Think Tank. Kacee Ting Wong is a barrister, part-time researcher of Shenzhen University Hong Kong and Macao Basic Law Research Center, and chairman of Chinese Dream Think Tank.
The views do not necessarily reflect those of China Daily.
