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Following is a question by the Dr Hon Joseph Lee and a verbal reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (July 9):
Question:
The Government recommends enhancing primary health care services in the health care reform consultation documents published in the past and this year. Yet, the existing allocation of resources for public health care services focuses primarily on the provision of treatment services, with 85% of the resources being spent on treatment of diseases and only 15% on disease prevention and health promotion. In this connection, will the Government inform this Council:
(a) of the authorities' plans to promote the development of primary health care services, and the specific ways to change the existing situation in which treatment services are given more weight in the allocation of resources for health care services;
(b) apart from implementing the electronic patients' record system to assist private medical practitioners and public medical institutions in treating patients, how the Government will promote the development of community and primary health care services through implementing the system; and
(c) of the specific plans to utilise the expertise of the health care teams so that they can make an impact on the community in the provision of primary health care services as proposed by the Government?
Reply:
Madam President,
First of all, I would like to provide some background information. Our public health expenditure stands at some $38 billion a year, accounting for some 55% of the total health expenditure in Hong Kong with the remaining 45%, i.e. about $30 billion, being private health expenditure (based on Hong Kong's Domestic Health Accounts 2004-2005). About 12% of the public health expenditure is spent on primary care, mainly on the provision of preventive public health services including disease prevention, health education and general out-patient services. Meanwhile, about 70% of the ambulatory care services are provided by the private sector with many of them being primary care services. Given the relatively low level of fees charged for primary care services, most members of the public can afford such services provided by the private sector. We should strive to instil into members of the public a sense of self-responsibility and commitment for their own health. Therefore, we should give due regard to the respective roles of both the public and private sectors in examining the development of primary care services.
My reply to various parts of Dr Hon Joseph Lee's question is as follows:
(a) In the Healthcare Reform Consultation Document "Your Health, Your Life" , enhancing primary care services is one of the major areas of our healthcare reform as it could help improve the health of the whole population and contain general healthcare needs and expenditure growth in the long run. To achieve the objective of enhancing primary care services in the long run, we will put in place the following initiatives detailed in the Consultation Document:
กฏ Developing models and standards for primary care services;
กฏ Establishing a Family Doctor Register;
กฏ Subsidising patients for preventive care;
กฏ Purchasing of subsidised public healthcare services from the private medical sector; and
กฏ Strengthening public health education and promoting healthy lifestyle.
The Working Group on Primary HealthCare under the Health and Medical Development Advisory Committee (HMDAC) chaired by me will take forward the above initiatives shortly. Besides, we have already launched pilot projects for the purchase of primary care services from the private sector in Tin Shui Wai as well as the elderly healthcare voucher scheme. We will make use of the additional health funding provided by the Government in the coming few years to carry out the reform in this respect. However, in the face of ageing population, increasing health care needs and rising medical cost, in order for the primary care services reform to be sustainable, especially in relation to subsidising the public to receive preventive care and improving the public primary care services, we need to address and reach an early consensus on the issue of long-term healthcare financing to ensure the availability of adequate resources to take forward the primary care reform on a continuous basis.
(b) Primary healthcare is the first point of contact in a continuing healthcare process for individuals and families and constitutes the first level of care in the context of the healthcare system. Our vision for developing electronic health record sharing is to enable healthcare providers, including primary care practitioners, to enter, store, retrieve and access health-related data of individuals subject to the individuals' authorisation for provision of holistic care, referral of patients in need to different levels of care for treatment, and effective follow-up of patients. This can help enhance the continuity of care and improve the integration of different healthcare services. Our long-term objective is to extend the coverage of electronic health record sharing to all primary care practitioners, including doctors, nurses and other allied health professionals and healthcare personnel providing primary care services, so as to promote the development of community and primary healthcare services and foster collaboration between different healthcare professions in the provision of primary care.
(c) Whole-person care requires comprehensive and thorough understanding of the patient's problems that affect his/her health and deriving solutions that resolve these problems. In Hong Kong, as we mentioned in the consultation paper "Building a Healthy Tomorrow" as early as in 2005, the emphasis of primary care is often put on treatment of episodic diseases only. Problems beyond the patient's physical condition are seldom dealt with fully. If there can be more collaboration between healthcare professionals and other professionals (such as community nurses, dieticians, occupational therapists, etc.) in the investigation and resolution of the patient's overall problems, better results will be achieved.
For the above reasons, besides Western medicine practitioners, Chinese medicine practitioners, dentists and chiropractors, nurses, physiotherapists, occupational therapists, radiographers and medical laboratory technologists are also eligible to register for participation in the Elderly Health Care Voucher Pilot Scheme. Elderly persons can use the vouchers for services provided by allied health professionals and laboratory test services (the use of such services is subject to the current referral arrangement) as well as curative or preventive medical services. In developing our future models of primary care services and expanding our subsidised primary care services, we will also study the roles of different healthcare professionals in the provision of primary care services. As for public general out-patient services, the Hospital Authority has progressively pooled together various allied health professions to offer a host of integrated healthcare services (such as the services of nurse clinics or allied health professions) for further enhancement of the public primary care services through the healthcare teams.
In sum, our target is to join hands with various healthcare professions, be they in the public or private sector, to take forward the primary care services reform and develop models and standards for primary care services. We aim to raise the quality of public primary care services while fostering the healthy development of private primary care services.
Ends/Wednesday, July 9, 2008
Issued at HKT 13:06
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