Appendix A – Hong Kong’s Current Healthcare System

Hong Kong’s public and private sectors provide comprehensive healthcare services, including a low‑cost public healthcare safety net that ensures no one in Hong Kong is denied medical care due to lack of means.  

The Health Bureau (HHB) formulates policies and allocates resources for healthcare services, with the aim of protecting and promoting public health, providing lifelong holistic care to every resident and ensuring no one is denied medical help due to lack of means.

The Department of Health (DH) is the public health authority and executes policies and statutory functions. It safeguards the community’s health through promotional, preventive, curative and rehabilitative services. 

The Hospital Authority (HA) provides public hospital and related services.  It offers medical treatment and rehabilitation services through hospitals, SOPCs, GOPCs, CMCTRs, and community outreach services.

The Primary Healthcare Office (PHO) was established on 1 March 2019 directly under HHB to oversee and steer the development of PHC services at the bureau level.  PHO focuses on the development of DHCs as a new model leveraging on public-private partnership and medical-social collaboration to cater for the needs and characteristics of the districts and enhance public awareness of healthy living, disease prevention and self-management of health.  It has also been tasked to spearhead the overall review and future development of PHC services.  

Hong Kong has an excellent healthcare system supported by a highly professional team of workers. The infant mortality rate in 2020 was among the lowest in the world. Male and female life expectancy at birth was among the world’s highest in 2021.

Hong Kong’s Domestic Health Accounts show total health expenditure increased from 3.6% to 6.7% of GDP from 1989/90 to 2019/20. Over the same period, public health expenditure ($101.5 billion in 2019/20, or 3.6% of GDP) rose from 40% to 54% of total health expenditure. The Government’s recurrent funding for health has risen by about 63% over the past five years, from $58.7 billion in 2016 to $95.9 billion in 2021. Year-on-year, the recurrent funding for health grew more than 10% from $87.1 billion in 2020. It accounted for 19% of the Government’s recurrent expenditure in 2021.  

PHC is the first point of contact in the healthcare process.  It covers a wide range of services, including health promotion and disease prevention, general out-patient and allied health services, and special services for people in specific age groups who do not need immediate hospital attention.    

General out-patient and allied health services are provided mainly by the private sector and NGOs.  In 2020/21, private Western clinics handled more than 18 million out-patient visits.  NGOs operate community clinics, and many also organise health promotions and educational activities.  Some NGOs provide health assessments for the elderly and medical check-ups for women.

The public sector provides PHC services mainly through the DH, the HA and DHCs.  PHC is being delivered using a lifecourse approach through the DH’s various areas of work with emphasis on preventive care.  The HA operates 73 GOPCs, including 3 CHCs, used mainly by the elderly, low-income families and chronic disease patients.  In 2021, some 1.7 million people used these services, with 6.3 million attendances recorded. 

To enhance district-based PHC, HHB aims to set up DHCs in all 18 districts.  Each DHC is operated by an NGO with government funding to promote medical-social collaboration, public-private partnership and district-based services.  It focuses on primary, secondary and tertiary prevention, including health promotion, health assessment, screening and managing chronic diseases, and community rehabilitation.  

Following the commencement of operation of Kwai Tsing, Sham Shui Po, Tuen Mun, Wong Tai Sin, Southern and Yuen Long DHCs, DHC in Tsuen Wan district will also commence operation in 2022. Smaller-scale interim "DHC Expresses" have been established in the other 11 districts since September 2021.  

The DH provides health promotion and disease prevention services to the community particularly for infants, children, women and the elderly through the following services.

There are 31 Maternal and Child Health Centres and three Woman Health Centres that provide immunisation, parenting, health and developmental surveillance, and breastfeeding support for children from birth to five years of age and women aged 64 or below. Antenatal, postnatal, family planning and cervical screening services and health education are also offered for women. Some 16,000 expectant mothers and 35,000 newborn babies attended such centres in 2021.

There are 13 Student Health Service Centres and four Special Assessment Centres that provide health screening and individual counselling to primary and secondary students. Eight school dental clinics provide preventive dental services, including annual check‑ups and basic care. At special schools, students with disabilities can use these services until age 18. In 2020-21, about 336,700 or 94 per cent of all primary students participated in such services. At special schools, students with disabilities can use these services until age 18.

Eighteen Elderly Health Centres provide PHC to people aged 65 and above, including assessment, treatment, education and counselling, and 18 VHTs which promote health activities for the elderly and provide training to carers. In 2021, there were about 38,000 enrolments and 133,000 attendances for health assessment and medical consultation, as well as some 280,000 attendances at promotional activities organised by the Elderly Health Service.

The EHCV Scheme subsidises the elderly to receive private primary care in the community that best suits their needs. The annual voucher amount for each eligible person is $2,000, with a maximum accumulation limit of $8,000. The government keeps the scope and utilisation of the scheme under review to strengthen its effectiveness and enhance primary, especially preventive, care for the elderly.  

The Hong Kong Childhood Immunisation Programme protects children against vaccine‑preventable diseases such as tuberculosis, hepatitis B, poliomyelitis, tetanus, pertussis, measles, diphtheria, mumps, rubella, chickenpox, pneumococcal disease and human papillomavirus (for school girls of suitable grades). Pertussis vaccinations are provided for women between 26 and 34 weeks of pregnancy, as part of routine antenatal care at maternal and child health centres.

The Government Vaccination Programme and the Vaccination Subsidy Scheme provide free or subsidised seasonal influenza vaccinations respectively from October each year to eligible people, including children and those aged 50 or above. The vaccinations are provided through kindergartens and child care centres, primary and secondary schools, public hospitals and clinics, residential care homes for the elderly and for persons with disabilities, residential child care centres, and designated institutions serving people with intellectual disabilities. Starting from November 2022, the scope of eligible groups under various seasonal influenza vaccination programmes has been expanded to cover those aged less than 18 (or secondary school students). 

The government provides screening for cervical cancer, colorectal cancer and breast cancer. The Cervical Screening Programme encourages women aged between 25 and 64 who ever had sex to undergo regular screening while the Colorectal Cancer Screening Programme subsidises asymptomatic residents aged between 50 and 75 to undergo screening. From September 2021, the Breast Cancer Screening Pilot Programme has provided screening services for eligible women, aiming to detect breast cancer before symptoms appear so that early treatment can be carried out. 

Community outreach healthcare aims to reduce reliance on inpatient services and help patients recover in the community. In 2021, the Hospital Authority conducted 2.01 million home visits and outreach care services for, among others, the elderly and people with mental illness. Around 85% of those receiving the HA’s community nursing services are elderly. Community geriatric assessment teams visit residential care homes for the elderly regularly to provide medical and nursing care to frail residents who are unable to attend SOPCs. These teams also train carers at the homes to care for their residents. Patient Support Call Centre provides support to high-risk elderly patients discharged from public hospitals, offering advice on disease management and care support, and arranging referrals to appropriate services for patients in need. 

The Government’s policy on dental care seeks to improve oral health and prevent dental diseases by raising public awareness of oral health and encouraging improved habits through promotion and education. Educational activities include the Brighter Smiles for the New Generation for pre-school children and the Bright Smiles Mobile Classroom for primary students, while the annual Love Teeth Campaign encourages good dental habits. Eleven government dental clinics provide emergency services in pain relief and tooth extraction, while six public hospitals offer specialist oral health care services. The Government also monitors the level of fluoridation in public drinking water to reduce dental decay.  

Under the Outreach Dental Care Programme for the Elderly, teams set up by NGOs receive government subsidies and provide free on-site oral check-ups for elderly people and oral care training to caregivers in residential care homes, day care centres and similar facilities. Free dental treatment will be provided on-site or at a dental clinic if necessary. The Healthy Teeth Collaboration programme provides free oral check-ups, dental treatment and oral health education for adults with intellectual disabilities aged 18 or above through NGO dental clinics. The Special Oral Care Service provides dental service for pre‑school children under six years old with intellectual disabilities at the Hong Kong Children’s Hospital, and provides on-site dental check-ups and oral health education for eligible children at special child care centres. 

The government adopts an integrated approach in promoting mental health, encompassing prevention, early identification, timely intervention and rehabilitation. Cross sectoral and multidisciplinary support and care services are available through collaboration among government bodies and other relevant organisations including the Health Bureau, Labour and Welfare Bureau, Education Bureau, Hospital Authority, Social Welfare Department and Department of Health.  

The Hospital Authority is a major medical service provider for people with mental disorders. Its psychiatric services include inpatient facilities, day hospitals, specialist outpatient clinics and community outreach. In 2020-21, about 275,800 people received treatment and support through these services. In 2021-22, the authority has earmarked additional funding of around $156 million to address the escalating demand for psychiatric services.  

The Advisory Committee on Mental Health advises the government on mental health policies and follows up on recommendations in the Mental Health Review Report. In March 2021, the committee initiated a pilot scheme to provide timely assessment, intervention and support to children and adolescents with mental health needs through medical-social collaboration.  

In September 2021, the committee began the second phase of the mental health promotion and public education initiative ‘Shall We Talk’. Over 855 organisations signed the Mental Health Workplace Charter that aims to promote a mental health friendly workplace, benefiting more than 510,000 employees. To address the impact of the COVID-19 epidemic on public mental health, the government earmarked $300 million for the committee to launch the Mental Health Initiatives Funding Scheme. 

These services are available mainly in the HA’s hospitals and SOPCs. As at end-2021, the city had 30 105 public hospital beds, comprising 23 774 general beds, 1 981 infirmary beds, 3 675 beds for the mentally ill and 675 for the mentally disabled. There were also 5 050 private hospital beds, comprising 4 682 inpatient beds and 368 day beds; 6 465 beds in nursing homes and 874 in institutions run by the Correctional Services Department. There were 5.6¹ beds per 1 000 population. Public hospitals spent $52.8 billion on inpatient services in 2020/21 and discharged 1.81 million inpatients and day inpatients in 2021.  

The HA’s SOPCs arrange appointments for new patients based on the urgency of their clinical conditions, to ensure those with acute conditions receive priority. Patients in stable condition are referred to family medicine and GOPCs, or to primary care practitioners in the private sector for follow-up. In 2021, the HA’s SOPCs recorded 8.19 million attendances.  

In 2019/20, spending on both public and private inpatient and specialist out-patient services totalled about $96.9 billion, of which 73% was spent on the public sector. In 2020/21, the HA’s specialist clinics spent about $14.9 billion on providing medical services.  

Allied health professionals working under the HA include audiologists, clinical psychologists, dietitians, OTs, optometrists, orthoptists, PTs, podiatrists, prosthetists and orthotists, speech therapists and medical social workers. They provide rehabilitative and extended care to help patients receiving inpatient, out-patient, ambulatory and community care services to reintegrate into society. In 2021, the authority’s allied health outpatient departments recorded 3.08 million attendances. 

Eighteen public hospitals provide accident and emergency services, delivering a high standard of service for critically ill or injured people and victims of disasters. 

Patients are classified under five categories according to their clinical conditions: critical cases come under Category 1, emergency cases under Category 2, urgent cases under Category 3, semi-urgent cases under Category 4, and non-urgent cases under Category 5. The triage system ensures patients with more urgent needs receive prompt treatment. In 2021, all Category 1 patients received immediate treatment and over 95% of Category 2 patients were treated within 15 minutes.  

These services spent some $4.3 billion in 2020/21 and handled 1.87 million visits by 1.14 million people in 2021, an average of about 5 100 attendances per day.

Specialist facilities under the DH include 19 methadone clinics, 17 chest clinics, eight social hygiene clinics, four dermatological clinics, one integrated treatment centre, four centres and clinics providing services related to clinical genetics, seven child assessment centres and two travel health centres. These facilities recorded around 2.1 million attendances in 2021. 

Fees for public hospital and clinic services are government-subsidised at a rate of 97.3%. Under a medical fee waiver mechanism, the HA grants waivers to needy groups including CSSA recipients, low-income patients, Higher Old Age Living Allowance (including Guangdong and Fujian scheme) recipients aged 75 or above, the chronically ill and elderly patients with financial difficulties.  

Private hospitals complement the public sector by providing a range of specialist and hospital services. The 13 private hospitals, including one commissioned in 2021, providing 5 050 hospital beds as at end-2021. The private hospitals served 276 723 inpatients in 2020, representing 15% of the city’s total number of inpatients. Spending on private inpatient services amounted to $26.5 billion in 2019/20, accounting for 36% of overall expenditure on public and private inpatient services.

The Government takes part in clinical PPP programmes through the HA. Services include cataract surgery, haemodialysis, radiological investigation, colon assessment, glaucoma treatment, trauma operation and breast cancer surgery. The HA’s GOPC PPP Programme subsidises clinically stable patients with HT and/or DM under the care of its GOPCs to opt for primary care from the private sector. A Co-care Service Model, developed in late 2021, enables clinically stable patients under the HA’s SOPCs to receive healthcare from the private sector. 

Voluntary Health Insurance Scheme aims to regulate the quality of individual indemnity hospital insurance products and improve market transparency, providing consumers with greater confidence in purchasing health insurance and private healthcare services, thereby alleviating pressure on the public healthcare system. As of end-2021, the number of scheme policies reached 980,000. 

The Government is constructing the first Chinese medicine hospital in Hong Kong, promoting service development, education and training, innovation and research. In June 2021, the Government announced that Hong Kong Baptist University (HKBU) would be the contractor of the hospital’s operation. The hospital is expected to begin services, in phases, from 2025.  

The Government Chinese Medicines Testing Institute specialises in testing and scientific research of Chinese medicines aiming to set internationally recognised standards. The temporary institute began operating in 2017 and publishes research results on the Chinese Medicine Regulatory Office website. The construction of the permanent institute began in June 2021 and is expected to be commissioned in 2025. 

At the district level, the 18 CMCTRs promote the development of Chinese medicine through services, training and research, under a collaboration model involving the HA, NGOs and local universities. The Government provides an annual quota of around 620 000 subsidised Chinese medicine out-patient attendances, covering general consultation, acupuncture and bone setting/tui na services. There were about 1.28 million attendances in 2021.  

The HA implements the Integrated Chinese‑Western Medicine Programme at designated public hospitals to gain experience in providing Chinese medicine inpatient services in stroke care, musculoskeletal pain management and cancer palliative care. The number of participating hospitals increased to eight in April, covering all seven of the authority’s hospital clusters. The number of participating hospitals has increased to eight, covering all seven of the authority’s hospital clusters.

Private Chinese medicine clinics record about 9 million attendances each year

The $500 million Chinese Medicine Development Fund provides subsidies which benefit numerous segments of the sector, including training in Chinese medicine, enhancing manufacturing practices for proprietary Chinese medicines, improving clinic facilities and supporting scientific research and promotional activities. The then Food and Health Bureau launched a review on the overall implementation of the fund in 2021.  

In August 2021, streamlined approval procedures allowing Hong Kong registered proprietary Chinese medicines for external use to be registered and sold in the Guangdong-Hong Kong-Macao Greater Bay Area (GBA) and an arrangement for selected public healthcare institutions in the GBA to recruit Hong Kong Chinese medicine practitioners were implemented. 

The Centre for Health Protection under the DH works with local and international counterparts to prevent and control diseases in Hong Kong. It works on three principles: real‑time surveillance, rapid intervention and responsive risk communication. The Centre keeps track of communicable diseases and issues surveillance reports and laboratory data reports regularly.  

The Prevention and Control of Disease Ordinance specifies 51 statutory notifiable infectious diseases in Hong Kong. The Centre continually reviews and updates its strategies for coping with major outbreaks of infectious diseases, including an influenza pandemic, the Ebola virus disease, measles, Middle East Respiratory Syndrome, Zika virus infection and dengue fever, ensuring both the government and the community are prepared to deal with them.  

To prevent and control the cross‑boundary spread of infectious and other serious diseases into or out of Hong Kong, the DH’s Port Health Division enforces health quarantine measures according to the International Health Regulations and the Prevention and Control of Disease Ordinance.  

Non-communicable diseases including cancer, cardiovascular diseases, chronic respiratory diseases and DM together accounted for about 55% of all registered deaths in 2020. 

The Government is implementing ‘Towards 2025: Strategy and Action Plan to Prevent and Control Non‑communicable Diseases in Hong Kong’, which sets out nine targets to be achieved by 2025 and a portfolio of initiatives to reduce the burden of non‑communicable diseases.  

The Hong Kong Cancer Strategy aims to reduce the cancer burden in the local population and improve the quality of life and survivorship of cancer patients. The Government promotes as the primary preventive strategy the adoption of a healthy lifestyle, which includes no smoking, avoiding alcohol consumption, eating a balanced diet and engaging in regular physical activity. 

The Department of Health is also coordinating the implementation of two other action plans, which set out strategies and priorities to eliminate the health threats posed by antimicrobial resistance and viral hepatitis.

The DH’s Health Promotion Branch (HPB) formulates and implements strategies and measures to promote healthy eating, regular physical activity and mental wellness to target groups at different settings. The HPB also updates information and health advice on infectious diseases and produces materials in various languages to raise awareness among ethnic minorities of how to prevent communicable diseases and adopt a healthy lifestyle.  

The DH works closely with Healthy Cities projects, NGOs and other community partners and solicits their support to carry out health promotion activities, disseminate health information, alert the public to health threats and facilitate implementation of preventive measures.