Strategic vision, new policies for prevention-oriented healthcare
This article appeared originally in the China Daily on 27 November, 2022.
Authors: Pamela Tin, head of healthcare and social development, and Bubble Lui, Assistant Researcher at Our Hong Kong Foundation.
The Hong Kong Special Administrative Region government has announced policies that promote primary healthcare development at all levels of the health system in the 2022 Policy Address. Some notable announcements include the establishment of the Primary Healthcare Authority at the governance level for coordination; the enhancement of the existing Elderly Health Care Voucher Scheme to incentivize primary-care uptake; and the introduction of a brand-new Chronic Disease Co-Care Pilot Scheme to motivate chronic disease identification.
It is thrilling to see the government’s continuous dedication to primary healthcare development and commitment to reorienting the health system from being treatment‑oriented to being prevention-focused. However, to realize the benefits of a primary-care-led health system, a strategic vision must be complemented with policy implementation that must come hand in hand with consideration for encouraging citizens’ uptake of services.
Hong Kong’s longstanding treatment-oriented health system has shaped citizens’ healthcare-seeking behaviors that are characterized by seeking help only when feeling unwell, with less emphasis on disease prevention. It will indeed take time and effort to change habits. To achieve this, relevant authorities must look at policy implementation from an end-user perspective that considers ways to promote behavioral changes to enhance the uptake of primary care.
Clearly, the government has considered ways to promote behavioral changes as shown in its attempt to encourage older adults to use primary healthcare services by enhancing the Elderly Health Care Voucher Scheme to include a monetary incentive, in which the additional HK$500 ($64) will be allotted automatically to the elderly persons’ accounts upon their claiming at least HK$1,000 from the voucher for designated primary healthcare services such as disease prevention and health management. This consideration of human psychology to prompt behavioral change is a good starting point, and more, similar efforts should be in place to successfully shift our system toward a primary-care-led health system.
Leveraging behavioral science to facilitate primary-care development
Behavioral science is the scientific study of human behaviors and has been readily applied in public policy to better people’s lives. The understanding of human behaviors can facilitate policy implementation, and this interconnectivity between public policy and behavioral science has become increasingly well-recognized. Governments around the world have begun to apply behavioral science in public policy, and various governments such as the United Kingdom, United States, Germany, Australia, Canada and the Netherlands have created dedicated behavioral-science teams to conduct rigorous research and generate evidence-based ideas to enhance public policy.
Carefully framing primary-care promotion to reach peoples’ mind
Behavioral science can be applied to primary-care promotion to increase service uptake. Using cancer screening as an example, the government’s populationwide Colorectal Cancer Screening Programme for citizens aged 50-75 is one of the most significant cancer screening programs in recent years. However, despite the initial fecal occult blood test (FOBT) being fully subsidized, research has shown that program uptake has not been ideal, reaching just 21.4 percent in 2018-19 among the target age group, according to the Department of Health. To enhance the uptake rate of similar screening programs, behavioral science strategies should be considered in program promotion. The Centre for Health Systems and Policy Research at the Chinese University of Hong Kong published a cancer-care policy brief in 2022, in which they conducted a behavioral experiment on 408 local individuals aged 18-49 and found that factors such as emphasizing that colorectal cancer screening can reduce an individual’s probability of death caused by colorectal cancer can increase people’s willingness to participate in the colorectal cancer screening program.
This is consistent with a famous theory in behavioral science called the “framing effect”, in which the way information is presented can influence one’s decision. Considering humans are risk averse, the careful framing of primary-care services promotion has significant impacts on individual behaviors. Therefore, the government should have a good understanding of the population’s current knowledge, attitudes, and behaviors toward primary care, and leverage behavioral science theories to better frame primary-care services promotion.
Cleverly designing primary-care programs to enhance service uptake
Another famous use of behavioral science in health policy is the “default state”, which means the option citizens are opted into. Research has found that people tend to do things that require the least effort, thus often going with the default option.
The design of a primary-care program’s default state is crucial. Taking the same colorectal cancer screening example as above, the National Health Service (NHS) in England makes use of the default option in their screening program where all citizens aged 50-74 who are registered with a general practitioner will automatically receive a mail every two years including an invitation and a free colorectal cancer screening fecal immunochemical test (FIT) kit that can be performed at home and sent to the laboratory. The use of an automatically opt-in default state and the minimization of citizens’ effort results in an uptake rate of 67 percent in 2021-22, according to the NHS. This suggests that minimizing citizens’ efforts in searching for and accessing primary-care services can greatly increase the service uptake rate, and therefore, the government should consider this people perspective when designing Hong Kong’s primary-care programs.
It is exciting to see the government’s efforts in supporting a major health-system transformation vital for health system sustainability. In addition to ensuring the governance and service infrastructure in place, the government must also consider leveraging behavioral science to encourage individuals’ uptake of primary-care services, such as using the framing effect in primary-care services promotion as an immediate application or carefully considering the default state when designing programs in the long term, to truly shift our system toward a primary-care-led health system.