Enriching Knowledge for the Health Management and Social Care Curriculum Series ：
Community Health
Booklet 10
Health Care System
September 2016
S5 – Macro Level
Health Management
Booklet (6) (8) (9) (10 )
Social Care Booklet (7) (11)
S4 – Holistic Health
Booklet (3) Physical Booklet (4)Mental Booklet (5) Social
S4 – Concepts and Framework
Booklet (1) Personal development Booklet (2) Health and well-being
Round-up：Booklet(13) Health and Social Care Policies
Macro Level
Health Management
Disease Prevention / Medical Care
Booklet 6 Healthy Community
Booklet 10 Healthcare
System
Health Promotion
Booklet 8 Ecology and
Health
Booklet 9 Building a Healthy City
Social Care
Booklet 7 Caring Community
Booklet 11 Social Welfare
System
Learning Targets
• Understand that value judgments may vary among different individuals or parties
• Respect cultural and ideological differences
• Appreciate alternative healthcare practices
Values and Attitudes
• Analyse and appreciate viewpoints or issues from different perspectives
Skill
• Understand how the development of
healthcare system is affected by social factors
Knowledge 10.1
• Understand the concepts related to health care
Knowledge 10.2
• Compare healthcare policies in Hong Kong with other regions /countries
• Identify the issues and concerns related to the health care system
• Understand the conflicts and tensions in the healthcare Knowledge
10.3-4
10.2 Healthcare System in Hong Kong
Topic 4 - Promotion and Maintenance of Health and Social Care in the Community
4E Health and social care professions and volunteers complementing primary /
private care
4E1Primary care
To understand the concepts of primary care
10.2 Healthcare System in Hong Kong
Primary medical care
• first point of contact that patients make with their doctors, such as general practitioners
• covers curative and preventive care, continuing care, health promotion and education
• referral to specialists
Secondary medical care
• specialist medical care
• hospital care
• include acute and convalescent
in‐patient care, day surgery, specialist out‐patient, and Accident and
Emergency services
Tertiary medical care
• highly complex and costly hospital care,
• the application of advanced
technology and multi‐disciplinary specialized
expertise
• such as organ transplants and
radio-surgery of the
brain
10.2C Medical and Health Services
Topic 5 - Health Promotion and
Maintenance and Social Care in Action
5B Health and social care services and agencies
5B1 Health and social care services
agencies: government departments’ and non-government organisations’ (e.g.
NGOs) provision of health care and social care services
To identify different types of health and social
care services
10.2C Medical and Health Services
Healthcare Services Primary Clinic
Services (Public)
Public：general outpatient services of Hospital Authority
Private：doctors and clinics
Registered Chinese medicine practitioners and listed Chinese medicine practitioners
Family Health
Maternal and child health centres
Woman health centres
Family Planning Association Student
Health
Student health service centres and special assessment centres of Department of Health
School health inspectors pay regular visits to schools to check on their environmental hygiene and sanitation standards
Annual visits to primary schools to vaccinate students against communicable diseases
Elderly Health
Elderly health centres and visiting health teams of Department of Health
Community Health
(Specific)
Community health service
Ambulatory care centres / integrated palliative day care centre of
Hospital Authority
10.2C Medical and Health Services
Healthcare Services Secondary,
Tertiary and Specialised Healthcare Services
Specialist Outpatient Service
Hospital Authority’s specialist clinics：internal medicine, surgery, as well as obstetrics, gynaecology, paediatrics, orthopaedics and traumatology, ear nose and throat, neurosurgery, oncology and cardiothoracic surgery. Many hospitals also have subspecialist clinics for cardiology, respiratory
medicine, kidney disorders and other illnesses Acute Inpatient
Service
Inpatient services are offered to patients who require intensive therapy for their acute illness
Accident and Emergency Services
The hospitals provide service for people critically ill or injured who need urgent medical attention, or for victims of disasters
Physiotherapy Concerned with human function and movement, to maximize potential as well as to promote, maintain and restore physical, psychological and social well-being
Occupational therapy
Provide daily living skills evaluation and training, home modification to increase function and safety, education in use of adaptive equipment, and activities to promote upper-limb capacity
Dietetic advice Identify nutrition problems, assess the nutritional status of patients, develop care plans, monitor the effectiveness of dietary changes and provide dietetic advice regarding patients’ health status
10.2D Alternative Healthcare Practices
Topic 4 - Promotion and Maintenance of Health and Social Care in the Community
4A Disease prevention (primary, secondary and tertiary) and using precautions in our daily living patterns and lifestyles
4A6 Options for alternative health care practices and services, e.g. traditional Chinese medicine,
acupuncture, naturopathy
To appreciate alternative health care practices
10.2D Alternative Healthcare Practices
Traditional Chinese Medicine (TCM)
• Health is achieved through balancing yin and yang
• A disease is caused by an imbalance leading to a blockage in the flow of qi (vital energy)
• Treatment: regulation of yin and yang
Acupuncture
• Involves the insertion of fine needles at
specific points on the skin, aiming to restore and maintain health through the
stimulation of specific points on the body called meridians
Naturopathy
• To support the body's ability to heal itself through the use of dietary and lifestyle changes, together with complementary
alternative medicine
therapies such as
herbs, massage, and
joint manipulation
10.2 Healthcare System in Hong Kong
•
Topic 3 – Responding to the Needs in the Areas of Health (care, promotion and maintenance) and Social Care
•
3C Implementing health and social care policies
•
3C2Public and private sectors and their roles in care services
3C3 Responsibilities, financing and structure of public agencies
To explain the health care system of Hong Kong and comment on its role in policy
implementation
10.2 Healthcare System in Hong Kong
Policy Objective：
to ensure no one is deprived of medical care because of lack of means
Food and Health Bureau
- Policy Making
Hospital Authority Responsible for the
management of all public
hospitals and provides medical treatment and rehabilitation services to patients through hospitals, specialist clinics and outreaching services
Department of Health
Provides promotive, preventive, curative and rehabilitative
services
Secondary, Tertiary and Specialised Healthcare
Disease Prevention
Primary Healthcare
10.2 Healthcare System in Hong Kong
Hospital Authority
Responsibilities Managing and
developing the public hospital system and establishing public hospitals
Financing totally financed by government funding through taxation
Structure
independent organisation
Secretary for Health and Welfare is responsible for the formulation of health policies and monitoring the performance of the Authority
Regional clusters are managed by Cluster Chief Executives
10.3F Public and Private Sectors and their Roles in Healthcare Services
Topic 3 – Responding to the Needs in the Areas of Health (care, promotion and maintenance) and Social Care
3C Implementing health and social care policies
3C2 Public and private sectors and their roles in care services
To explain the health care system of Hong Kong and
comment on its role in policy implementation
Health Expenditure
Inpatient Service (bed days)
Private 10%
Public 90%
Private 70%
Public 30%
Public Private
49 % 51 %
Hong Kong’s Dual-track Healthcare System
Dual-track Healthcare System
• Public Healthcare
(27 000 beds; 5 400 doctors):
• 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 Healthcare
(4 000 beds; >5 000 doctors):
• Complements public healthcare
• Choice for those who can afford and willing to use private healthcare services
• With personalised choices, enhanced privacy and more
accessible services
10.3F Roles of Public and Private Sectors
• Responsible for delivering information for public good
Disseminations of health information
• Providing free or below-cost public services to the disadvantaged groups
Safety net for the disadvantaged groups
• Responsible for regulation, education and information for consumers to make efficient choices of the health services
Protecting consumers
• to achieve equity by financing and providing services in areas where demand is insufficient to stimulate private provision
Advocating equity
Burden of Public Sector
Adjusting balance the between
Public Private and Sectors
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
Strengthen Public Safety Net
Enhance Primary
(From 2010)
Care
Review Regulation of
Private Healthcare
Facilities (From 2012)
Promote Public- Private Partnershi
p (PPP)
(From 2007)
Develop Electronic Health Record (eHR) Sharing
(From 2009)
Review Healthcare
Manpower Planning
(From 2012)
Voluntary Health Insurance
Scheme
Adjusting the Balance of Public-Private Healthcare Sectors
medical insurance or saving to
encourage patients
Increase the healthcare expenditure in publicsector, i.e. deploy more manpower and resources in public sector to meet the increasing demand
Strengthen disease prevention – health promotion to achieve healthy lifestyles that reduce demand of health services for
chronic patients
Advantages of Increased
involvement of the private sector
Release the financial
tension
• encourages higher income segments of the population to use the services provided by the private sector
• control of the expanding cost: from being the major service provider to subsidizing the services with cost controlled
Reduce demand on
public sector
• extends consumer choice - private medical practitioners may be located in areas convenient and may be available during more convenient time for the service users
• the subsidy of the services provided by private sector makes it affordable to those patients willing to pay
Relieve the workload in
short term
• participation of private medical and health professionals instantly provide more human resources for the treatment of patients
Reduce the waiting time
and waiting list
• with subsidy, some patients may choose services provided by private sector to reduce the waiting time
• the waiting list for the treatment in public sector will be shortened as some of the patients my choose services provided by private sector
Public-Private Partnership
Tension
Competing resources
Resources allocated to develop public services or subsidy private services in long term
Different visions,
expectations and perspectives
Public
provide healthcare to all regardless of the ability to pay; focus on the health needsPrivate market-oriented, cost- effectiveness, profit-making
Crisis
Quality of services decline/ malpractice
maximize profit
lower workforce ratio to reduce the cost Ineffective use of
resources
Monitoring the quality of services provided by the private sector Obstruct the coordinated service
delivery that best fit the clients
lack the information and expertise to make informed choices on public or private
services to attend
Dominated by the
private sector
health services become fragmented,
poorly planned and badly coordinated
10.1 Development of Healthcare System in Hong Kong
Topic 2 - Health and Social Care in the Local and the Global Contexts
2D Developments in the health and care industries
2D6 Changing infrastructure of health care
To understand how the development of health and care industries are affected by the
systemic factors, issues and concerns
10.1 Development of Healthcare System in Hong Kong
Topic 3 – Responding to the Needs in the Areas of Health (care, promotion and
maintenance) and Social Care
3C Implementing health and social care policies
3C1Development of the health care system in Hong Kong
To explain the health care system of Hong
10.3 醫療改革
•
課題二 本地與全球健康與社會關懷的情境
•
2D健康及社會關懷行業的發展
•
內容：(6)
健康護理制度結構的轉變，例如：引入醫療融資的模式
•
目的：
–
明白系統性因素、議題及關注如何影響健康與
關懷行業的發展
–
從不同角度分析相關的看法或議題
–
明白到不同人士或組織的價值判斷會有不同
10.1 Development of Healthcare System in Hong Kong (1)
Period Issues and Concerns
Medical Care Health Policy / System
Disease Prevention
Role of public / private
sectors 1840s -
1950s
• Became a British colony
• Influx of migrants from China
• Outbreak of plague
• mainly served by private traditional Chinese medicine
practitioners / relatively few hospitals / most of the hospitals and medical
equipment served the officials
• minimum medical service provided by
governme nt / no healthcare system or health policy
• mainly on public health measures that dealing with the work after outbreak (such as ‘Washing Tai Ping Tei’)
Mainly
provided by private
sector – mainly
provided by private
Chinese
Practitioners
10.1 Development of Healthcare System in Hong Kong (2)
Period Issues and Concerns
Medical Care Health Policy / System
Disease Prevention
Role of public / private
sectors 1950s -
1980s • Population expansion
• Industrialisati on and
economic development
• rapid expansion of hospital number and
facilities to serve the general public
• provision of subsidized or free
medical and personal health services
• concept of disease prevention emerged , e.g.
immunization programmes provided by Department of Health to
children from new born to late childhood
Expanding contribution of public sector - expanding public medical services, e.g.
hospitals and
clinics
Period Issues and
Concerns Medical Care Health Policy / System Disease
Prevention Role of public / private sectors After
1980s
• Social issues, e.g. poverty, ageing population
• Expanding public expenditure
• secondary and tertiary care mainly provided by public sector, primary care mainly
provided by private sector
• collaboration of private and public sectors
• cost-effectiveness was emphasized - setting up Hospital Authority to oversee and manage the provision and delivery of services of all government and subvented hospitals
• control of healthcare expenditure -
consultation on healthcare financing models / charges for some medical services provided by
government
• collaboration of public and private sectors to provide more service choices
• strengthen the
prevention and control of the outbreak as well as the international collaboration, e.g. set up of Centre of Health Protection (CHP) after SARS
• strengthen the health promotion campaigns
Increasing involvement of private sector - collaboration between public and private sectors
10.1 Development of Healthcare System in Hong Kong (3)
10.3 Healthcare Reforms
Topic 3 – Responding to the Needs in the Areas of Health (care, promotion and
maintenance) and Social Care
3C Implementing health and social care policies
3C1 Development of the health care system in Hong Kong
To express personal opinions on health care
policies
10.3 Healthcare Financing in Hong Kong
Hong Kong Public Private
General taxation, Health insurance plans, Out-of-pocket payments
Paid by service users
Private health insurance of individuals or employers Hospital
services (higher cost)
90% hospital care
Individuals cover around 3% of the cost for public hospital services by out-of-pocket payments and/or health insurance
Medical safety net to assist patients with financial difficulty in paying public hospital bills
Fees and charges for private hospital services are covered by out-of-pocket payments and/or health insurance
Primary healthcare services
30% outpatient services
Patients who cannot afford private sector services can use subsidized public services
70%outpatient services
Patients pay full cost for services in the private sector
Medicines Patients are required to pay a small Patients pay full cost for services in
Healthcare Reform:
A Historical Timeline of Public Consultations
1993 2000
2005 1999
Mar 2008
1985
Dec 2014
Oct 2010
10.3 Healthcare Reforms – Reasons
Ageing Population
• The ageing trend in Hong Kong's population has
continued and about 27% of Hong Kong's population will reach the age of 65 or above in the 2030s
Dependency Ratio
• Old-age dependency ratio:
the number of working age persons (age 15 - 64 years) per older person (65 years or older)
• Drop in birth rate implies that there will be less and less young people who can help share the livelihood expenses (including medical expenses) of the elderly population
Expansion of Healthcare Expenditure and Services
• The ageing population will accompany an increase in chronic diseases, and the strain on treatment,
rehabilitative and relevant social services will also increase. The demand for hospital beds (public sector) will increase with age. Thus, the demand for services in public sector is expected to increase largely
Private
10.3 Rethinking the reasons
When people live longer…
Increased demand for health care related to chronic illnesses such
as cardiovascular and cerebrovascular diseases
Expanding Needs for Health Care in Public Sector
Lack of income after retirement
Rely on the healthcare services provided by public sector
Expanding public expenditure on health care
Healthy Lifestyle??
?
Primary care/
community care / private care??
Retirement Protection
??
Less than other
10.3E Health Care Systems in Different Countries
Market-oriented countries
• Rationale
• Individual needs should be satisfied by the private market and family
• Allocation of resources according to consumers’
willingness to pay
• Policy objectives
• To minimize government intervention. Government only provides assistance through Medicaid and Medicare to the low-income individuals and families
• Feature of service provision
• Private Insurance,
supplemented by Medicaid and Medicare
• Example: USA
Welfare states
• Rationale
• Everyone is entitled to reasonable access to health care, regardless of the ability to pay
• Policy objectives
• To provide universal services for all people
• To provide access to a
comprehensive range of health services
• Feature of service provision
• National Health Service (NHS), e.g.
• 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
• Example: UK, Canada
Mixed model
• Essential health services are available with reasonable access regardless of the ability to pay but private health services are
available to those who can afford either to pay or with insurance coverage
• To ensure no one in Hong Kong is deprived of medical care because of lack of means; at the same time emphasizing individual
responsibility for the
maintenance of his or her own health.
• The public sector is the predominant provider of secondary and tertiary care.
Individuals cover a small
percentage of the cost for public hospital services. A large
proportion of primary care is
UK Australia USA
General taxation, national Insurance premiums,
health insurance plans and out-of-pocket payments.
General taxation.
Medicare levy.
Health insurance plans.
Out-of-pocket payments
Private Insurance
Hospital services
Free of charge for eligible persons unless they choose to be treated as private patients
Public patients in public hospitals are free of charge.
Private patients in either public or private hospitals receive 75%
government subsidy on medical services and cover all other costs by out-of-pocket payments and/or health insurance.
The level of access to healthcare services is determined by the level of insurance cover which an individual can afford to purchase
Contributions are based not only on the ability to pay but also on an
individual’s health risk assessed by the insurer
Primary healthcare services
Fully subsidized by public money, patients receive primary
healthcare services provided by private medical practitioners free of charge
Patients receive government subsidy to cover 85% of the cost on private out- of-hospital services and the remaining 15% is covered by out-of-pocket
payments but not by health insurance.
Medical safety net will provide assistance to those patients with difficulty in handling payments.
Medicines Patients are required to pay a flat rate for each prescription
Exemptions granted to specific groups such as
Patients are required to make a co- payment for acquiring government- subsidized prescription medicines.
Safety Net in USA
States
Medicare
hospital insurance
all persons over the age of 65
disabled persons
supplementary medical insurance
The aged and disabled persons
who pay a monthly premium
Medicaid Individuals and families with low
10.4 Conflicting Agendas in the Healthcare Reform
•
Topic 3 – Responding to the Needs in the Areas of
Health (care, promotion and maintenance) and Social Care
•
3D Cultural and political disagreements and tensions
3D2 The debates and practical / political conflicts
between the roles of the individuals (private sector) and the public or government in the provision of social care and health services responsibility of the government, e.g.
Medical charges
Competitive or complementary roles between the public sector and the private sector
Privatisation
To understand the conflicts and tensions in the health and
social care context
10.4 Conflicting Agendas in the Healthcare Reform
Expanding Public Sector Expanding Private Sector
Pros • Ensuring the provision of services in meeting the needs of patients: the provision is not dictated by market but by needs and the availability of resources.
• Strengthening the safety net: the government is pursuing social goals that profit-seeking, market- oriented, private sector organisations overlook or play down, e.g. equity and poverty alleviation
• Ensuring the implementation of health policy in coordinated and planned efforts
• Consumers, i.e. the patients, may have more choices as privatisation fosters competition / new ideas in the market
• The waiting list for the services provided by public sector may be shortened when more services are provided by the private sector
• The financial burden of the government may be reduced as some of the medical expenses are shared by the consumers who are willing to pay
• The accessibility of services increases as private providers may be located in convenient areas and offer services during more convenient times for customers
• The services may be more sustainable as they are independent of changes in government policies and budgetary constraints
Cons • Concern for public expenditure / government financial burden / sustainability of healthcare financing - the costs of secondary / tertiary medical care are relatively high and will continuously
increase under ageing population
• Comparatively fewer choices and less flexibility in catering the needs of patients
• Lower the extent / degree of personal responsibility in healthcare
• The profit-seeking and market-oriented private sector
organisations may overlook or play down the social goals such as health equity and primary health care
• To maximize profit, services produced in the private sector may be operated at a lower workforce ratio to reduce the cost. This may affect the quality of services provided
• As the prices are determined by the market, the service providers have no intention to keep the prices low and
affordable. Patients who are less able to afford the services will
Should the resources be allocated to public or private sectors?
10.4 Conflicting Agendas in the Healthcare Reform
Public Responsibility
• The responsibility of the Government to provide medical care:
• For all citizens, or
• For the deprived
groups at an affordable price
Private Responsibility
• Those who can afford should take up their
responsibility in paying the health and care
services
• User charges should be increased? How much should be raised?
Private vs. Public Responsibility？
10.4 Conflicting Agendas in the Healthcare Reform
Financing Principles – Percentages to be paid by Users and Tax Payers
Public services are funded by taxation and public expenditure on healthcare is increasing
From the tax payers’ point of view, it is reasonable to use the public healthcare
services no matter how much they are taxed.
The huge subsidy invested in the system, plus the improving standards, have not only attracted those who
cannot afford to the public sector, but also a substantial number of patients who can afford to pay more
Overloading of public sector
10.4 Conflicting Agendas in the Healthcare Reform
Priorities of Resource Allocated to Primary Care or Specialized Services？
Primary Care Specialized Services
Primary care and
community medicine, will become
increasingly important in managing the growing
number of chronically ill patients as the elderly
population increases
Priority is given to
hospital-based services for the past decades instead of across
different types
of services
10.4 Conflicting Agendas in the Healthcare Reform
•
