The Hong Kong Special Administrative Region government is formulating its first five-year plan. I, as a medical doctor, propose that the policy direction for healthcare development under the five-year plan should be divided into three parts: How to ensure Hong Kong’s medical and health sector can fulfill the tasks assigned by the central government; how to integrate into and contribute to the national 15th Five-Year Plan (2026-30) in areas such as “Healthy China”; and how to tackle and resolve local healthcare issues. I will share my thoughts on this.
Hong Kong has held the title of the world’s highest life expectancy region for over 10 consecutive years. According to figures released by the SAR government, in 2024, the life expectancy at birth for males in Hong Kong was 83 years, and for females, 88 years. Hong Kong’s infant mortality rate ranks among the lowest in the world. Data from the Census and Statistics Department show that the infant mortality rate dropped significantly from 91.8 per 1,000 registered live births in 1951 to 1.7 in 2024. Hong Kong also leads the world in the cure rates for several types of cancer, with the five-year relative survival rate for cancer patients in Hong Kong rising by 10 percentage points over the past decade to reach 56 percent. These figures amply demonstrate that Hong Kong possesses an outstanding public health system, high-quality medical technology, and a widespread public awareness of health.
Hong Kong boasts a world-class healthcare standard, and Bloomberg has repeatedly announced that the city has one of the most efficient healthcare systems globally. With healthcare expenditure accounting for only 7.5 percent of its GDP — compared to approximately 17.5 percent in the United States — both the SAR government and local residents spend relatively less to achieve world-leading health outcomes. While these achievements are commendable, the question is whether they can be sustained. Geopolitical tensions have made the international and local economic environment unpredictable; an aging population is putting pressure on the healthcare system; and the growing number of the kinds of diseases, coupled with costly treatments, all pose challenges to the sustainability of Hong Kong’s healthcare development.
Hong Kong operates a dual-track healthcare system with both public and private sectors running in parallel, yet current services are heavily skewed toward the former. In addition to further promoting public-private collaboration, the government should leverage the strengths of civil society and charitable organizations. At present, Hong Kong has about 16,000 medical practitioners serving a population of 7.5 million, or 2 doctors per 1,000 population, far below the World Health Organization’s recommended ratio. Although there are around 10,000 Chinese Medical Practitioners (CMP), they handle only about 10 percent of the medical workload. One major reason is that current regulations restrict CMPs from using modern diagnostic tools such as X-rays and blood tests. Therefore, it is essential to amend the legislation to enable CMPs to take on more responsibilities, and to further strengthen collaboration between CMPs and Western medicine.
It is hoped that in the future, we can leverage our strengths to meet various challenges, simultaneously contribute to Hong Kong’s high-quality development, and better integrate the city into and serve the overall national development
In the government’s consultation document for Hong Kong’s five-year plan, four major policy directions for healthcare development are proposed: improving the primary healthcare system; deepening public healthcare reform; promoting smart healthcare and healthcare information infrastructure development; and enhancing CMP services and CMP-Western medicine collaboration.
With regard to “improving the primary healthcare system”, the government is currently advancing primary healthcare development in all aspects, including setting up district health centers or district health stations in all 18 districts to provide essential primary healthcare services to the public. At present, these district health centers do not have resident doctors; they are mainly staffed by nurses, physiotherapists, and other allied health professionals. This arrangement is far from ideal. The government should actively engage private doctors in the community to provide and supervise services at these centers, thereby promoting public-private partnerships and working together to strengthen primary healthcare.
With regard to “deepening public healthcare reform”, the Hospital Authority currently employs over 90,000 staff, of whom less than one-tenth — about 7,000 — are frontline doctors. Consideration should be given to increasing the number of frontline doctors, streamlining other personnel, and improving organizational structure to enhance capacity and efficiency. Furthermore, under the dual-track healthcare system, the public sector serves as a safety net, using over HK$100 billion ($12.75 billion) in public funds to serve 90 percent of the city’s population. Very few governments in the world can permanently afford to cover the healthcare needs of all or most of their citizens. Therefore, with limited manpower and resources, the public healthcare system should focus on the four pillar services: emergencies, complex cases care, the underprivileged, and the training of medical and allied health personnel. Residents who are better off financially should make good use of private healthcare services and avoid overusing public services, thereby alleviating the pressure on the public system.
Many residents are dissatisfied with the long waiting times and long lines in public healthcare. If the public system could concentrate on the four pillar services, the situation would be significantly improved. In fact, the Hospital Authority already has a triage system in place: Attending physicians will discuss the clinical condition and needs with the patients, then schedule the consultation or surgery appointment based on the urgency of the condition, rather than solely on a first-come-first-served basis. However, many residents are unaware of this arrangement. So the government should do a better job in public relations, stepping up external explanation, publicity, and education. As to fee charging, the principle of “user pays, and those who can afford more pay more” should be upheld; the accident and emergency fee is a good example of a reform in this direction.
The government should also proactively collaborate with the insurance industry to offer better medical insurance products to the public, so that more people are covered by insurance and the healthcare system can continue to perform at a high standard.
Strengthening public-private partnership is equally important. At present, Hong Kong has about 7,000 doctors in the public sector serving 80 to 90 percent of the population, while about 9,000 doctors in the private sector serve the rest. This mismatch of manpower leads to an imbalance, so public-private collaboration needs to be further enhanced. For example, for cataract surgeries, the Hospital Authority invites eligible patients who have waited a long time to join the Cataract Surgeries Programme, where they receive a fixed subsidy to undergo surgery in private clinics. This is a highly successful public-private partnership initiative.
Hong Kong private healthcare services are very efficient and of world-class standard, and this level should be maintained. Although some voices in the community criticize private healthcare for being expensive, Hong Kong has one of the highest costs of living in the world, and everyday expenses such as housing, food, transport, and clothing are also high, so it is inevitable that private medical fees are relatively high. Moreover, the high returns help attract top talent to join the medical profession, which, in the long run, ensures the quality and efficiency of private healthcare services.
With regard to “promoting smart healthcare and healthcare information infrastructure development”, further advancement requires the clarification of the allocation of responsibilities. Take for example, the use of artificial intelligence (AI) to analyze X-ray results: If the AI fails to detect a tumor in the X-ray image, leading to an incorrect diagnosis, who should be held responsible? During the AI analysis process, the input data and its volume are critical. If the input data is entirely correct, it will lead to accurate analysis results; if the data is flawed, the analysis will be erroneous — garbage-in, garbage-out. Therefore, questions arise: Which AI tool should the hospital use? Who is responsible for inputting data into the AI? Is the input data correct? Even if the data is entirely accurate, if the AI still produces an incorrect result through machine and deep learning — the black box — who should bear the responsibility? Hence, it is necessary to clarify accountability, rather than placing all blame on the doctors.
In addition, current telemedicine services have limitations. With technological advancements, public demand for telemedicine is gradually increasing, but Hong Kong currently faces restrictions in promoting telemedicine. For instance, the professional guidelines of the Medical Council of Hong Kong and the Chinese Medicine Council of Hong Kong recommend against using telemedicine for the first consultation, so most local healthcare institutions do not accept direct telemedicine consultations for new cases. Such restrictions hinder the development of telemedicine and should be overcome to make services more responsive to patient needs and more cost-effective.
With regard to “enhancing CMP services and CMP-Western medicine collaboration”, the government released the Chinese Medicine Development Blueprint last year, expressing full support for the development of Chinese medicine, with the aspiration of turning Hong Kong into a bridgehead for CMPs to go global. However, the current legislation concerning CMPs still imposes restrictions. Last year, the Chinese Medicine Council of Hong Kong’s Practitioners Board issued the Guidelines for Registered Chinese Medicine Practitioners Referring Patients for Diagnostic Imaging and Laboratory Tests (the Referral Guidelines), with the Hong Kong Chinese Medicine Hospital as a pilot site, permitting registered traditional Chinese medicine practitioners, when serving as members of the clinical team responsible for a patient’s primary care at that hospital, to refer patients to radiographers and/or medical laboratory technologists within the hospital’s clinical team for additional tests in accordance with the hospital’s internal clinical guidelines. At present, the Referral Guidelines only apply to plain X-ray examinations. Current legislation still leaves most CMPs in Hong Kong confined to the traditional methods of “inspecting, listening, inquiring, and palpation”, which are extremely outdated compared with the Chinese mainland and the rest of the world. I hope the government will amend the relevant regulations as soon as possible and expand the scope of application of the Referral Guidelines, while strengthening CMP training in this area, so as to further promote CMP-Western medicine collaboration and benefit more patients.
As an ophthalmologist, I would like to talk more about the eye service part, which currently faces two major issues. First, waiting times in the public healthcare system are excessively long, and the number of people on waiting lists is too high. Taking cataract surgery as an example, according to government figures, during the period from April 2025 to March 2026, the median waiting time for patients who underwent surgery across various hospital clusters ranged from seven to 25 months. The fastest, most logical, and most effective solution is for the government to actively promote public-private partnership to improve the situation. The precedent for this is the Cataract Surgeries Programme, which successfully assisted the Hospital Authority in the past.
The second eye healthcare issue is myopia. There are two types of myopia: low-degree myopia, which may cause inconvenience only; and high myopia exceeding 600 degrees, which can be pathological and lead to blinding conditions such as macular disease, retinal detachment, and glaucoma. Myopia is a disease that cannot be ignored. President Xi Jinping has stated that this is a major issue concerning the future of the nation and the people, and it must be highly prioritized rather than left to develop unchecked.
The prevalence of myopia in Hong Kong is the highest in the world, with the myopia rate among 6-year-old children at approximately 25 percent. Therefore, as early as 2017, the author, in the ophthalmology sector, teamed up with the University of Hong Kong, the Chinese University of Hong Kong and the Hong Kong Polytechnic University to submit a proposal to the government, advocating for the establishment of a working group to prevent and control myopia. The central government had designated myopia control as a national policy a decade ago, and this year set a target to control the myopia rate for 6-year-olds to around 3 percent by 2030. Hong Kong’s current situation has fallen significantly behind the nation and we need to catch up quickly. We, the local ophthalmologists, have taken the lead again to establish a working group with international specialists, local universities and other organizations to effectively prevent and control myopia. We have made workable proposals to the government and hope the government will give us its blessing with policies and financial support to ensure good eyesight for our kids as soon as possible, otherwise Hong Kong will be paying much more to treat the complications of high myopia, including glaucoma, macular and retinal diseases, which have been estimated to cost HK$4.63 billion in the future.
Hong Kong possesses world-class healthcare. It boasts leading clinical achievements and technologies, the highest global life expectancy, and a highly efficient dual-track healthcare system. It is hoped that in the future, we can leverage our strengths to meet various challenges, simultaneously contribute to Hong Kong’s high-quality development, and better integrate the city into and serve the overall national development.
The author is a member of the Chief Executive’s Policy Unit Expert Group, and an honorary associate professor at the University of Hong Kong.
The views do not necessarily reflect those of China Daily.
