10) Health Care System

1. Primary health care

Including: health promotion, illness prevention, care of the sick, advocacy and community development
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	such as 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
Governance	Health Bureau	policy making
	Hospital Authority	management of public hospitals, specialist clinics and related outreaching services
	Department of Health	providing promotive, preventive, curative and rehabilitative services

4. Roles of public and private sectors

Public

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

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 & 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 and 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	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 subsidising 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
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

7. Healthcare Systems in Different Countries

	Market-oriented countries	Welfare states
Rationale	individual needs should be satisfied by the private market and family allocation of resources according to consumers’ willingness to pay	everyone is entitled to reasonable access to health care, regardless of the ability to pay
Policy objectives	to minimize government intervention- Government only provides assistance through Medicaid and Medicare to the low-income individuals and families	to provide universal services for all people to provide access to a comprehensive range of health services
Example	USA - private Insurance, supplemented by government aid (Medicaid and Medicare)	UK - National Health Service - 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

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