PHC is the first point of contact for individuals and families in a continuous healthcare process in the living and working community which entails the provision of accessible, comprehensive, continuing, co-ordinated and person-centred care. A well-established and overarching PHC system routinely manages, maintains and enhance the health of the population at the community level, forms the foundation and portal of the pyramid of healthcare services, and serves as a gatekeeping role to specialised secondary and tertiary healthcare in hospital and institution settings. It is recognised as the most essential component in a well-functioning healthcare system.

PHC development in Hong Kong could be traced back to the document Health for all, the way ahead: Report of the Working Party on Primary Health Care in 1990. The Working Party reviewed the Government's role and objectives in health and PHC. It was aware that the Government sector shared 15% of all out-patient medical consultations. With rising public expectations for quality healthcare and need to promote PHC, the “public assistant for all” approach was no longer appropriate. The Government should not aim to become the sole or main provider in primary medical care. The Government’s role should be emphasised on public health and preventive care through multi-sector co-ordinated collaboration, and ensuring and improving the quality and standard of primary care, as well as providing primary care for those who cannot afford private healthcare. The Report affirms the importance of PHC and provided a list of 102 recommendations toward its development.

In the following 10 years, the establishment of the HA in 1990 and the public consultations in 1993 and 1999⁴⁷had brought the public’s attention to the restructuring of public healthcare services and healthcare financing, which eventually revealed the importance of PHC reform again in 2000, with the release of the consultation document Lifelong Investment in Health. The recommendations include strengthening preventive care, developing Chinese medicine services, transferring the DH’s GOPCs into the HA for integration of primary and secondary care in public sector, and developing electronic Health Information Infrastructure.

In 2005, the Health and Medical Development Advisory Committee reviewed the service delivery model for the healthcare system, and issued a discussion paper Building a Healthy Tomorrow. The recommendations include promoting the concept of family doctor, the target services of public healthcare, purchasing primary care services from the private sector, and facilitating the collaboration among healthcare professionals for co-ordinated care.

Building on the recommendations, the Government put forward a comprehensive proposal in Your health Your life Consultation Document on Healthcare Reform and published the Report on First Stage Consultation in 2008. The recommendations include establishing a family doctor register, developing basic models for primary care services, promoting PPP, subsidising target groups for preventive care, and purchasing primary care services from private sector. The principles of good primary care received positive feedback from the public and healthcare stakeholders. Some respondents expressed support to the establishment of a PHC authority for the planning, co-ordination and governance of PHC services. The Government reconvened the Working Group on Primary Care (WGPC) and three Task Forces under the WGPC to advise on strategic directions for primary care development in 2008.

Based on the strategies and recommendations proposed by WGPC and its Task Forces, the Government published the Our partner for better health – Primary Care Development in Hong Kong: Strategy Document in 2010. The recommendations include setting up a Primary Care Office (PCO), developing Reference Frameworks and Primary Care Directory, and piloting Community Health Centres and networks to devise service models with comprehensive and co-ordinated PHC services through cross-sectoral collaboration in the community.

Following the announcement in the 2017 Policy Address, the Steering Committee on Primary Healthcare Development was set up in November 2017 to develop the blueprint for the sustainable development of PHC services for Hong Kong.

In the 2017 and 2018 Policy Addresses, it was announced that the Government is committed to enhancing district-based PHC services in order to effectively change the current focus of healthcare services on treatment to alleviate the pressure on public hospitals by setting up DHCs in 18 districts progressively. Against this backdrop, the PHO was established on 1 March 2019 directly under the HHB to oversee and steer the development of PHC services at the bureau level. PHO focuses on the development of DHCs as a new service model and spearheads the overall review and future development of PHC services. With the setting up of PHO, PCO was formally integrated into PHO in October 2019 to allow better use of healthcare resources and to streamline the roles and responsibilities of the two offices.

The development of PHC in Hong Kong is briefly illustrated in Figure C.1. The recommendations in the policy and consultation documents for PHC development since the Report in 1990 is set out in Figure C.2.

figure_c.1.jpg — Figure C.1
PHC Development in Hong Kong

Table C.2:

The recommendations in the policy and consultation documents for the development of PHC

Recommendations

Policy areas	Health for all, the way ahead: Report of the Working Party on Primary Health Care (1990)	Lifelong Investment in Health consultation document (2000)	Building a Healthy Tomorrow discussion paper (2005)	Your Health, Your Life - Healthcare Reform Consultation Document and Report on First Stage Consultation (2008)	Our partner for better health – Primary Care Development in Hong Kong: Strategy Document (2010)	Policy Addresses in 2017 and 2018
Governance and quality assurance	Establish a statutory Primary Healthcare Authority with some degree of financial autonomy, with the DH as its executive arm, to oversee the delivery of PHC.	The DH to take up the role as the coordinator or regulator to ensure quality in the health care sector. Set up a Complaint Office in the DH to assist the patients in lodging complaints.		Set up Working Group on Primary Care. Establish a PHC authority to co-ordinate all primary care initiatives. Establish a family doctor register.	Set up a Primary Care Office for support and co-ordination of efforts for primary care across sectors. Develop Reference Frameworks and Primary Care Directory.	Set up Steering Committee on Primary Healthcare. Pursue the Accredited Registers Scheme for Healthcare Professions. Set up an Office for Regulation of Private Healthcare Facilities; introduce legislation to regulate Advanced Therapy Products. Complete and evaluate the Pilot Accredited Registers Scheme for Healthcare Professions.
Development of preventive and promotive PHC services	Strengthen the planning, policy, leadership, training and service on health education and promotion. Improve preventive care, including immunization, maternal and child care, family health, family planning, student health and other disease prevention and control services. PHC services in public and private sectors should be promotive and preventive, with better planning and co-ordination. Screening and health education programmes should target towards diseases or at-risk groups, and be evaluated.	Strengthen preventive care: work with all related sectors, including healthcare, education, environment and others. The DH to review the effectiveness of health education and promotion efforts. GOPCs should be redesigned for the financially vulnerable and those chronically ill. The DH to promote oral health to the community and students. The DH to support the development of Chinese medicine in Hong Kong. Pilot the practice of Chinese medicine in public hospitals.	Public healthcare should target the services for (1) acute and emergency care; (2) low income and under-privileged groups; (3) illnesses that entail high cost, advanced technology and multi-disciplinary professional team work; and (4) training of healthcare professionals.	Strengthen public health education, healthy lifestyle promotion, disease prevention, as well as development of and standard‐setting for primary care services.	Strengthen preventive approach to tackle major disease burden, particularly chronic diseases. Emphasise person-centred care and patient empowerment. Additional resources for pilot dental services for the elderly.	Set up a dedicated unit under HHB to oversee Chinese medicine development. establish a dedicated fund to promote Chinese medicine development. Introduce free HPV vaccination to school girls of particular age groups.
Service co-ordination and collaboration	Enhance the system for better collaboration between general and specialist out-patient services. More integrated community health services for elderly.	The DH’s GOPCs be transferred to the HA for integration of the primary and secondary care in the public sector. Develop a multi-disciplinary, multi-sectoral, community-based integrated healthcare model with medical social collaboration.	Promote the family doctor concept and continuity of care. Encourage group practice of private doctors and empowerment of patients. The public sector co-ordinates the planning and development of ambulatory services with private hospitals. Public hospitals establish referral protocols and shared-care programmes with family doctors for medically stable patients.	Develop basic models for primary care services.	Develop comprehensive care by multi-disciplinary teams. Improve continuity of care for individuals. Improve the co-ordination and collaboration of care among healthcare professionals across different sectors.	Regularise Dementia Community Support Scheme and extend it to all district elderly community centres.
Development of district health system	PHC services should be organised and administered in a district health system. Ngau Tau Kok Clinic and Yan Oi Polyclinic should be developed into DHCs for piloting service improvement.	Develop a community-focused, patient-centred and knowledge-based integrated health care service.	Establish a platform on a regional / district basis to facilitate collaboration among medical and other professionals.		Pilot projects on Community Health Centres and networks.	Set up District Health Centres, complemented by Satellite Centres, in 18 districts progressively.
Financing of PHC services	A charging policy should be adopted to identify the target groups for subsidised services and ensure no one be prevented from adequate medical treatment due to lack of means. Different subsidisation levels for different services and target groups.⁴⁸ Fee adjustment should be gradual and step-by-step. Study should be conducted leading to a policy statement on future health financing and service development.	Public funding should be allocated toward community-based services and based on population needs. Introduce medical savings through a scheme of Health Protection Accounts. Conduct a detailed study of the fees structure and how it can target subsidies at areas of greatest needs.	Purchase primary medical care services from the private sector. Develop more refined assessment to determine different subsidy level for patients with different needs.	Promote PPP; funding injection for Samaritan Fund and PPP projects. Subsidise target groups for preventive care. Purchase primary care services from private sector. Explore the idea of a “personal limit on medical expenses”. Public healthcare as a safety net for all, while providing better and wider choice in private healthcare. In line with the concept of “money‐follows‐patient”, while ensuring price transparency and cost-effectiveness.
Manpower supply and training for PHC	Enhance the role community nursing service through training and education; enhance public health nursing training and education. More training to improve occupational health. Enhance the training of doctors and nurses in GOPC and private practice, with clinic assistance to share less technical work. Enhance training and education on family medicine. Separate department of family medicine in the two universities. The DH to set up PHC training centres.	Promote family medicine practice by doctors, nurses and allied health professionals and provide the relevant training opportunities through the HA and GOPCs.	Encourage additional training and qualifications for the career of community nurse through universities and training institutions.		Support professional development and quality improvement.	Increase the number of publicly-funded healthcare training places; upgrade and increase the teaching facilities.
Data connectivity and health surveillance	Improve the collection, analysis and utilization of health information. Develop a computer-based clinical information system for GOPC. Expand the DH’s Statistical Unit to become a Health Information Unit. The DH to collaborate with other parties to carry out health services research. Set up Health Services Research Fund. Improve the communication of epidemiologic information between DH and private practitioners.	The DH to report the health status of the community regularly, carry out health impact assessment of socio-economic variables and different environmental problems. Develop an electronic Health Information Infrastructure to link up providers in the community. The HA to develop knowledge-management tools such as evidence-based clinical practices. Set up a Research Office in the Bureau.	Provide health information by government to improve preventive care.	Develop the infrastructure for sharing electronic health records in both the public and private sectors.	Develop a territory-wide patient oriented Electronic Health Record Sharing System (eHealth). Strengthen research on primary care.	Establish a steering committee to lead the study on strategies for developing genomic medicine in Hong Kong.

⁴⁷The Government invited public comments on the consultation document Towards Better Health - A Consultation Document about compulsory comprehensive insurance in 1993. The debate continued with the release of Harvard Report to recommend health security plan and saving accounts for long-term care and the consultation document Improving Hong Kong’s HealthCare System: Why and For Whom in 1999.

⁴⁸(1) Preventive care, including immunization, maternal and child care, family planning, student health and other services for the control of diseases should be free of charge; (2) Primary care, including screening, for those who cannot afford to pay (e.g. recipients of public assistance) should be free of charge; (3) Screening for elderly and at-risk groups aged 45 to 64 in GOPC and Well-woman Clinics should be at reduced charges; (4) Primary care for young children aged 0 to 15, full-time students up to the age of 18, elderly aged 65 and above, and recipients of disability allowance, should be half fee; (5) Community rehabilitation services, community nursing service and domiciliary occupational therapy service should be of high subsidisation level; and (6) Non-target group should not be charged above the cost.

Appendix C – The Development of Primary Healthcare in Hong Kong

Recommendations