System Health Care

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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


Health Promotion

Booklet 8 Ecology and


Booklet 9 Building a Healthy City

Social Care

Booklet 7 Caring Community

Booklet 11 Social Welfare



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



• 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



10.2 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


• such as organ transplants and

radio-surgery of the



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


 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


 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


 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


• 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


• 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



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


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


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


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)


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


Adjusting the Balance of Public-Private Healthcare Sectors

medical insurance or saving to

encourage patients

Increase the healthcare expenditure in public

sector, 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


• 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


Competing resources

Resources allocated to develop public services or subsidy private services in long term

Different visions,

expectations and perspectives


provide healthcare to all regardless of the ability to pay; focus on the health needs

Private market-oriented, cost- effectiveness, profit-making


Quality of services decline/ malpractice

maximize profit

lower workforce ratio to reduce the cost Ineffective use of


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











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 -


• 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’)


provided by private

sector – mainly

provided by private




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



Period Issues and

Concerns Medical Care Health Policy / System Disease

Prevention Role of public / private sectors After


• 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


• 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



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


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



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



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


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


• 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

Cost- Effectiveness vs. Clients’ Satisfaction

Cost- Effectiveness

• Due to the increasing public expenditure on health care, the Government has the challenge of long term

financial sustainability with the existing taxation system.

Procedures should be adopted to monitor and review the healthcare development in terms of

Clients’ Satisfaction

• Consumers’ rights

• Higher expectation on health and social welfare

• Demand higher quality of

services, such as better

facilities and amenities,

shorter waiting time, more

high-tech diagnostic tests

and drugs




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