Overview of the Primary Health Care System in Hong Kong
- Introduction
          Hong Kong average life expectancy is one the longest city among the world, even longer than some developed countries such as America, Japan (Lee et al., 2016). According to the statistic provided by the Department of Health in 2016, the life expectancy of Hong Kong male and female are 81.2 and 87.3 respectively. The reason why Hong Kong is having this honor can be related to various factors. Generally speaking, more and more people have started to take care of their health. For example, they have a variety of food choice, buying food from many places with a relatively reasonable price. The Hong Kong government also pays lots of effort in health promotion, like encouraging people to do enough exercise per week and eat healthily with less oil, salt, sugar etc. Citizens are able to find this kind of health information easily through television, advertisements, or the Internet. In terms of policy making, Hong Kong government has set up regulations restricting smoking in Hong Kong. Smoking in restricted area is prohibited, higher regulation in tobacco trading, as well as the advertisements of tobacco, posted or showed to the public. Together with the smoking cessation program provided by the government, the number of people smoke is kept decreasing throughout these years (Hong Kong Council on Smoking and Health, 2016).
Nonetheless, another important factor that makes Hong Kong people can have the longest life expectancy in the world is due to Hong Kong has a comprehensive health care delivery system. Including both public and private health services, from out-patient clinic, specialist out-patient clinic, even in hospitalization, Hong Kong health care system has a high quality and high standard of health delivery service. With the advanced medical technology, all the Hong Kong citizens can enjoy the health service, no matter what kind of economic status of oneself. They can use the health service. Everyone will be provided with adequate health care services provided by all health criteria. As a result, Hong Kong citizens can have a higher chance to have a longer life expectancy.
In the following paragraph, a brief overview of the current Hong Kong health care system will be discussed, followed by the discussion of one of the major roles of the whole system in Hong Kong, Primary Health Care, by looking at the working principles of the system and the services provided to the public. Last but not least, the health care system in Hong Kong though is comparatively perfect than other countries. There are some rooms of improvement, which will be discussed in the recommendation part.
- Hong Kong current Health Care System
Nowadays the health care system in Hong Kong is running under a dual-track system, they are public and private sectors. These sectors deliver different services from primary, secondary and even tertiary care. Public health care sector is the core of the whole healthcare system, providing health services to all the citizens. In other words, the public healthcare sector is the basic system in maintaining the health of the community. On the other hand, private healthcare provides an alternative choice for citizens to choose (Ko, 2013). These services usually have a higher cost, but will provide a more accessible and relatively higher quality healthcare service than public healthcare service. If clients can afford the cost, they may choose private health care service according to their own desire (Kong, 2015).
All public health care services in Hong Kong are regulated by the Food and Health Bureau, HKSAR. The major role of it is setting up policies and distributing resources to public healthcare services to operate and providing service for the community (HKSAR, 2016). Under the regulation of Food and Health Bureau, there are two more departments in providing different kinds of public health care services. The Department of Health is responsible for the management of public health like Chest Clinics, Student Health Services Centre, Maternal and Child Health Centres etc. The Hospital Authority is responsible for the management of public hospitals, for instance, public hospitals, general out-patient clinics, special out-patient clinics (HKSAR, 2016).
Private health care service, involve mainly hospital services, such as private hospitals, private practitioners, and private Chinese practitioners. All the private hospitals, private medical clinics are regulated by the Department of Health, and they should obey the Hospitals, Nursing Homes and Maternity Home Registration Ordinance (Cap. 165) and the Medical Clinics Ordinance (Cap. 343) (HKSAR, 2010).
     3. Primary Health Care Services
Primary health care is an important category in the health care system since it helps to maintain the health of the community, the work should be done effectively and comprehensively. This is because primary health care is the first step of contact between patients with their family members and health professional (WHO, 2008). Generally speaking, primary health care aims to prevent any disease occur in the early stage, as well as improve personal health condition. These kinds of actions can help in lower the opportunity of suffering diseases and thus, reduce the needs of a high level of health care like that more intensive health care. The whole health expenditure can be reduced for both the client oneself and also the whole health care system (HKSAR, 2008). A proper and effective development of primary health care system can benefit the use of resources and their allocation to another part of the system. For example, primary health care for elderly, treatment on long-term disease etc.
     3.1 Current Primary Heath Care Service in Hong Kong
Being the first contact point of the health care, primary health care does include health promotion, patient-based health care, disease prevention, and medicine care. In Hong Kong, primary health care services are mainly provided by the private family doctors, public health care sectors will integrate with those private health care sectors to provide different dimension of specialist and hospital services. However, patients have to pay for all of the cost to the private health care services. Public health sectors its own will provide general out-patient clinics, for those who cannot afford the cost of private primary health service (HKSAR, 2010). The Department of Health functions various public activities for community care. With the working principle of protecting the health of the whole community and the population, Department of Health will bring along with disease surveillance, communicable diseases control among the community, public health regulation as well as licensing, implement different kinds of health measures, such as tobacco control etc. (HKSAR, 2010). In order to provide a comprehensive health care, different discipline or health care professionals should work together, including general practitioners, nurses, Chinese medicine practitioners, and related health care professionals and health care providers among the community.
Early in 1990, the Working Party on Primary Health Care established a report, to have a comprehensive examination of the primary health care system in Hong Kong, as well as recommending the strategies in order to strengthen the system. Since then, different primary health care services started to be established. For example, in 1994, the Woman Health Service has been set up. Introduce health service for women who aged 64 or below. In 1995, the Student Health Service has been established, which give general medical checkup, health promotion etc. for primary and secondary students. Elderly Health Service was established in 1998, providing preventive care, giving support on elderly centres and elderly homes (Food and Health Bureau, 2010). Throughout the years, more and more primary health care services have been organised or being reformed.
In October 2008, a reform of the Working Group on Primary Care has been established by the Health and Medical Development Advisory Committee and operated by the Secretary of the Food and Health Bureau (Food and Health Bureau, 2010). The working group is mainly on providing advice on critical development for primary care. Several working tasks have been set up by the group including establishing primary health care conceptual models and related framework protocols, constructing the Primary Care Directory, and recommending an effective primary health care service delivery model (HKSAR, 2010). All these working principles are aiming at enhancing primary health care service in Hong Kong. The group is composed of both representatives of public and private sectors, for instance, patients group, health professionals, health administrators, and related stakeholders.
Regarding the working principles, the primary health care conceptual model and protocol is targeting on the conceptual models and guidelines on hypertension and Diabetes Mellitus for the use of health care professionals.
Primary Care Directory is a program set up by the Primary Care Office, which is under the regulation of the Department of Health, established in 2010. This program aims at supporting and coordinating primary health care service development in Hong Kong, establishing primary health care developing strategies and operation. The Directory is operated by different health professionals, health administrators, and related stakeholders from the Food and Health Bureau. In order to have a better co-operation between various disciplines, and to ensure they have relevant professional knowledge to develop primary health care system (Primary Care Office, 2017). The government will also help in training primary health care providers and collaborate with the Directory and those health professionals. The public can assess to the Primary Care Directory to search for their own primary health care providers according to their health needs.
In terms of community health networks, the Government will propose projects based on the conceptual models and consultation with the health care professionals, health care providers, public and private health care sectors, non-governmental organizations, and local universities. Aims at setting up localized health centre, provide a comprehensive and coordinate primary health care service to the community.
    3.2 Primary Health Care for Elderly
Aging population in Hong Kong is a serious problem, according to the statistic provided by the Census and Statistic Department in 2015, it is estimated that in mid-2024, 22% of the Hong Kong citizens are aged over 65 and over 65. Nonetheless, the number of elderly will keep increasing in the following years. 20 years later in 2044, the population rate for those aged 65 and over will become 31%. More elderly will have an effect on the labor workforce, more workers are needed to support those retired elderly (Tollefson, 2015).
The increase of number of elderly also will affect to the health care system. Normally, elderly will have a higher chance of developing chronic disease due to the decrease on the body mechanism. As a result, they will use health services more often. The government has to put more resources in maintaining the health of this population. For example, health promotion, more resources to the hospitals in curing the chronic disease, ensuring all the functional ability etc. (Sin et al., 2015). A comprehensive primary health care framework is therefore needed to be established in order to relieve the pressure of the medical services and also the whole health care system in a long-term, to achieve a sustainable development.
Primary health care in elderly is served as a preventive measure, a better control of the chronic disease etc. The services usually provided by the private family doctors. They will give health related information to the elderly, having risk assessment, and follow-up medication (Sin et al., 2015). The supportive measures not only help the elderly, but their family members also gain benefit from it. They can spend less time and money in paying for the health care service.
     4. Recommendations
     4.1 Allocation of the manpower
As mentioned, most of the tasks are performed by the Department of Health, the health professionals, like doctors, nurses, even the Secretary of the Food and Health Bureau is come from a medical background. The workload of the health professionals, especially those who work in hospitals, is very high. In fact, they almost need to perform all the tasks. There is not enough manpower to take care of a huge amount of clients every day. From paper work or even the driver of the ambulance are all health professionals. The government should revise of the job allocation in hospitals or related work field, to lower the workload of the health professionals, and thus, have a better working performance to provide a higher quality of health care to the clients.
     4.2 Use of Complementary and Alternative Medicine
Nowadays in Hong Kong is mainly use conventional medicine as medical treatment. Although it still has its effectiveness, Complementary and Alternative Medicine (CAM) therapy is an alternative way that can be used in public primary health care service. CAM therapy refers to an approach using together with western medicine, focusing on the treatment of a whole person (Mayo Clinic, 2014). The Hong Kong Baptist Hospital is one of the hospitals that provide Chinese Medicine medication. However, the use of CAM therapy is not quite common in public health care sectors, most of the therapies are provided by the private sector. Therefore it is suggested that the Government can build up or set up clinics that mainly use CAM therapy for primary health care, letting those who cannot afford the high cost of private health care sector. A combination of CAM therapy and traditional medicine lower the use of main hospital resources and as a result, a better resource allocation.
     4.3 A Balance between public and private health care sectors
As mentioned by Griffiths (2012), private sector is the major provider of primary health care, around 70% of it is provided by family doctor, private clinics etc. Moreover, there are more and more private clinics being established, since the practitioners want to have more economic income. Therefore, the two sectors can cooperate with each other, such as the General Outpatient Clinic Public Private Partnership is one of the ways to solve this problem (Cheung, 2015). Even clients whenever use the private health care service can enjoy a lower cost if they are transferred from the public sector. This can lower the workload and the number of clients in public sectors, and also the clients can have a relatively better quality of primary health care service. The Government shall implements effective and comprehensive strategies between public and private health care sectors.
      5. Conclusion
Being the longest life expectancy among the world, it is no doubt that Hong Kong has several of advantages owing to this result. As mentioned from the above, the quality and standard of the health care system in Hong Kong is higher than many developed countries. This plays an important role for community health development. Primary health care system is the first step for the medical treatment between clients and medical providers. Therefor an effective and comprehensive primary health care system is essential. This can lower the time spending on medical treatment afterwards. The resources using in the system can be reallocate. However the whole still has some problems, government should cooperate with public and private health care sector in order to implement an effective policy for providing adequate medical service to the community.
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