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RECOMMENDATION 1. Hong Kong should apply strategic
purchasing and leverage public-private partnerships as
a purchasing instrument with a strategic vision for
improving primary care accessibility in Hong Kong

Mechanisms for strategic purchasing should be an integral function of health system
governance in the planning process of the commissioning and purchasing of healthcare.
The application of strategic purchasing for enhancing primary care accessibility necessitates
these mechanisms to be aligned with strategic goals and operated across macro-, meso-
and micro- levels of the health system.

• What services to purchase? The Government should identify service gaps in the health
system and health goals that may be met through primary care services purchased. It is
critical to conduct population needs assessments and evaluations of
health goal prioritisation on a continuous and regular basis.
• Whether to provide or purchase? In parallel to the building of a primary care ecosystem
in the public sector that will take time, resources within our current portfolio must be
allocated more strategically to facilitate the purchase of prioritised primary care services.
Given that the private sector currently provides the bulk of primary care services in Hong
Kong, there is a need to better utilise private sector capacity in primary care provision.
While Hong Kong has used PPPs as a purchasing instrument to better leverage existing
resources from both sectors to provide care that meets population demands, a more
strategic approach which assesses the capacities and capabilities of
private and public sector providers in making decisions for
incorporating strategic purchasing mechanisms is necessary to guide the
purchase of care from the private sector to enhance the accessibility and affordability of
primary care for all.

• For whom to purchase? Programmes applying strategic purchasing should aim to
improve equitable health outcomes for all population groups through extending health
service (in this case, primary care) coverage, improving public access and financial
protection, advancing social equity while optimising health system efficiency using
defined or whole population targeting (WHO, 2017b). At the same time, the
targeted population should be well-informed of their entitlements.
• From whom to purchase? When selecting providers, purchasers should ensure that
provider operations are well-managed with clear service contracts. Regarding the actual
selection of service providers, capacity, availability, quality, efficiency, and
equity of service providers must be considered within the context of service
accessibility to encourage uptake. Efforts should be made to incentivise the
participation of service providers. The Government should involve
cross-disciplinary service providers to promote holistic person-centred care.
• Who to purchase? Purchasers of health services can be chosen from both the public and
private sectors (WHO, 2019b). All purchasers should work in synergy towards the same
set of health system priorities, using mechanisms that facilitate knowledge-
sharing between different purchasers. The Government should identify a
purchaser responsible for the provision of primary care in Hong Kong such as the Food &
Health Bureau, and clearly define its role.
• How to purchase? The Government and purchaser should assess how services will
be purchased and at what price, using a selection of demand- or
supply-side instruments, contractual terms and agreements, and
provider payment mechanisms that incentivise performance. Thought
should therefore be given to how best to integrate performance-based financing
(PBF) programmes into mixed provider payments systems to bridge gaps
between providers and purchaser expectations, and incentivise change among providers
for improving access and quality of services (WHO, 2017b).
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