Fee hikes are only half the equation if Hong Kong health reform is to work
Fee hikes are only half the equation if Hong Kong health reform is to work
Hong Kong introduced a public hospital fee overhaul at the start of the year in response to long-standing pressures from an ageing population, rising chronic diseases and growing expenditure. Early data from the Hospital Authority suggests the fee increases are having an effect.
From January 1-18, semi-urgent and non-urgent cases at accident and emergency (A&E) departments fell by 21.3 per cent year on year, while critical and emergency cases rose slightly, by 7.7 per cent. This indicates resources shifting towards more serious needs.
But pricing is only half the equation. While fee adjustments help balance the books and signal to the public that medical resources are scarce, they do not solve the fundamental problem: patients flood emergency rooms because they often have nowhere else to go, especially after dark. If we simply raise prices without providing viable alternatives, we risk penalising the vulnerable. To make this reform work for the people, not just the treasury, Hong Kong must simultaneously strengthen primary care, specifically evening and night services.
Hong Kong’s high-subsidy healthcare model is a double-edged sword. It has led to a doubling in government spending over the past decade, driven by demographic shifts and chronic conditions. With nearly 60 per cent of the roughly 2 million annual A&E visits involving semi-urgent or non-urgent cases, the system’s efficiency has been under scrutiny.
The Hospital Authority has made noticeable efforts, such as achieving a 20 per cent price reduction on drugs through bulk procurement. But fiscal measures cannot fix a service gap. The “family doctor for all” concept remains a work in progress.
Crucially, limited operating hours in the public sector create a bottleneck. Only 23 general outpatient clinics operate until 10pm on weekdays. For a working parent with a feverish child or an elderly resident in pain at 8pm, the choice is often stark: waiting at a crowded A&E department or paying private fees that may not be affordable.
To divert non-urgent patients from A&E departments effectively, simply expanding capacity is not enough. Patients need well-supported alternatives with clear guidance on which service to use and when. We cannot expect patients to self-triage effectively without adequate information and incentives.
Singapore’s strategies for managing emergency attendances, especially those with conditions better suited to primary care, provide valuable lessons. Its GPFirst programme, launched in 2014, fundamentally reshaped patient behaviour by prompting patients with mild to moderate conditions to visit general practitioners first.
Importantly, the system backs this up with incentives: referred patients receive priority access at A&E departments and a S$50 (US$39) subsidy, removing concerns that seeing a GP first will result in a delay or higher payment. This has driven results, including a 14 per cent drop in non-urgent cases and over 36 per cent fewer unreferred walk-ins at one regional hospital by 2019.
In addition, Singapore bridges the gap between A&E departments and family doctors through urgent care centres. These provide diagnostic tests, intravenous therapy, minor procedures and other services that go beyond a standard GP’s capability. Coupled with specialist-led training that equips primary care physicians to handle more complex cases in community settings, Singapore has built a “middle tier” of care.
Hong Kong should consider similar multilayered strategies, combining incentives, intermediate facilities, training and technology, rather than solely relying on added appointments to redirect non-urgent demand.
While primary care reforms are under way, including a plan to increase 25,000 night appointments in eight high-demand districts, the pace and scope must match the urgency of the fee adjustments. We should consider leveraging public-private partnerships to “buy” night capacity from the private sector. By subsidising private GPs to extend their hours to midnight, the government can instantly expand the evening service network.
Additionally, we must not overlook our unique asset, Chinese medicine. Hong Kong’s Chinese medicine clinics could be empowered to handle specific non-critical evening cases, such as pain management, further diverting traffic from hospitals.
Technology is the final piece of this puzzle. The “HA Go” app should be upgraded from a booking tool to a real-time triage companion. Imagine an app that shows a live map of nearby public clinics and partner private doctors with available slots and waiting times. Empowering residents with real-time data allows them to make smarter choices than simply heading to the nearest hospital.
Beyond managing acute demand, we must look upstream to prevention in improving health system sustainability. The Voluntary Health Insurance Scheme (VHIS) can be a helpful tool. On top of its focus on protection, it has the potential to prioritise prevention.
Proposals to include preventive screenings in the VHIS merit consideration. Early cancer detection can halve, even quadruple, treatment costs compared to advanced-stage care. While critics often cite the risks of overdiagnosis and premium inflation, these can be managed through clinical guidelines that target high-value screenings based on age and risk factors.
By covering screenings for average-risk groups who fall outside government subsidy schemes, VHIS can fill a critical gap. This would not only ease the long-term cancer burden on public hospitals but also shift the community mindset from cure-seeking to health maintenance.
Fee adjustments are a bitter pill, but they can be the catalyst for a healthier system if accompanied by genuine service improvements. By synchronising fee reforms with an expansion of night clinic services, lessons from models like Singapore’s and a prevention-focused VHIS, Hong Kong can build a healthcare system that is not only financially sustainable but also accessible, dignified and humane.
Hong Kong introduced a public hospital fee overhaul at the start of the year in response to long-standing pressures from an ageing population, rising chronic diseases and growing expenditure. Early data from the Hospital Authority suggests the fee increases are having an effect.
From January 1-18, semi-urgent and non-urgent cases at accident and emergency (A&E) departments fell by 21.3 per cent year on year, while critical and emergency cases rose slightly, by 7.7 per cent. This indicates resources shifting towards more serious needs.
But pricing is only half the equation. While fee adjustments help balance the books and signal to the public that medical resources are scarce, they do not solve the fundamental problem: patients flood emergency rooms because they often have nowhere else to go, especially after dark. If we simply raise prices without providing viable alternatives, we risk penalising the vulnerable. To make this reform work for the people, not just the treasury, Hong Kong must simultaneously strengthen primary care, specifically evening and night services.
Hong Kong’s high-subsidy healthcare model is a double-edged sword. It has led to a doubling in government spending over the past decade, driven by demographic shifts and chronic conditions. With nearly 60 per cent of the roughly 2 million annual A&E visits involving semi-urgent or non-urgent cases, the system’s efficiency has been under scrutiny.
The Hospital Authority has made noticeable efforts, such as achieving a 20 per cent price reduction on drugs through bulk procurement. But fiscal measures cannot fix a service gap. The “family doctor for all” concept remains a work in progress.
Crucially, limited operating hours in the public sector create a bottleneck. Only 23 general outpatient clinics operate until 10pm on weekdays. For a working parent with a feverish child or an elderly resident in pain at 8pm, the choice is often stark: waiting at a crowded A&E department or paying private fees that may not be affordable.
To divert non-urgent patients from A&E departments effectively, simply expanding capacity is not enough. Patients need well-supported alternatives with clear guidance on which service to use and when. We cannot expect patients to self-triage effectively without adequate information and incentives.
Singapore’s strategies for managing emergency attendances, especially those with conditions better suited to primary care, provide valuable lessons. Its GPFirst programme, launched in 2014, fundamentally reshaped patient behaviour by prompting patients with mild to moderate conditions to visit general practitioners first.
Importantly, the system backs this up with incentives: referred patients receive priority access at A&E departments and a S$50 (US$39) subsidy, removing concerns that seeing a GP first will result in a delay or higher payment. This has driven results, including a 14 per cent drop in non-urgent cases and over 36 per cent fewer unreferred walk-ins at one regional hospital by 2019.
In addition, Singapore bridges the gap between A&E departments and family doctors through urgent care centres. These provide diagnostic tests, intravenous therapy, minor procedures and other services that go beyond a standard GP’s capability. Coupled with specialist-led training that equips primary care physicians to handle more complex cases in community settings, Singapore has built a “middle tier” of care.
Hong Kong should consider similar multilayered strategies, combining incentives, intermediate facilities, training and technology, rather than solely relying on added appointments to redirect non-urgent demand.
While primary care reforms are under way, including a plan to increase 25,000 night appointments in eight high-demand districts, the pace and scope must match the urgency of the fee adjustments. We should consider leveraging public-private partnerships to “buy” night capacity from the private sector. By subsidising private GPs to extend their hours to midnight, the government can instantly expand the evening service network.
Additionally, we must not overlook our unique asset, Chinese medicine. Hong Kong’s Chinese medicine clinics could be empowered to handle specific non-critical evening cases, such as pain management, further diverting traffic from hospitals.
Technology is the final piece of this puzzle. The “HA Go” app should be upgraded from a booking tool to a real-time triage companion. Imagine an app that shows a live map of nearby public clinics and partner private doctors with available slots and waiting times. Empowering residents with real-time data allows them to make smarter choices than simply heading to the nearest hospital.
Beyond managing acute demand, we must look upstream to prevention in improving health system sustainability. The Voluntary Health Insurance Scheme (VHIS) can be a helpful tool. On top of its focus on protection, it has the potential to prioritise prevention.
Proposals to include preventive screenings in the VHIS merit consideration. Early cancer detection can halve, even quadruple, treatment costs compared to advanced-stage care. While critics often cite the risks of overdiagnosis and premium inflation, these can be managed through clinical guidelines that target high-value screenings based on age and risk factors.
By covering screenings for average-risk groups who fall outside government subsidy schemes, VHIS can fill a critical gap. This would not only ease the long-term cancer burden on public hospitals but also shift the community mindset from cure-seeking to health maintenance.
Fee adjustments are a bitter pill, but they can be the catalyst for a healthier system if accompanied by genuine service improvements. By synchronising fee reforms with an expansion of night clinic services, lessons from models like Singapore’s and a prevention-focused VHIS, Hong Kong can build a healthcare system that is not only financially sustainable but also accessible, dignified and humane.
