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Consultation Meeting on Hong Kong Future Healthcare Model

Legislative Council Health Service Legislative Council Health Service ConstituencyConstituency Office of Dr. Hon. Joseph Lee Kok Long Office of Dr. Hon. Joseph Lee Kok Long

15th September 200515th September 2005

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Building a Building a Healthy Healthy Tomorrow ?Tomorrow ?

Summary & Fruits for thought of Summary & Fruits for thought of Discussion Paper on the Discussion Paper on the

Future Service Delivery Model Future Service Delivery Model for our Health Care for our Health Care

SystemSystem

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Existing Health Care Model Curative careCurative care Hospital services should be able to Hospital services should be able to

provide the best care for patientsprovide the best care for patients

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Future Service Delivery Model Preventive care and continuity of

care Home and family care play Home and family care play

important rolesimportant roles

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What should our future service delivery model be? Re-emphasize the importance of Re-emphasize the importance of

primary medical careprimary medical care Ensure our limited resources Ensure our limited resources

appropriately utilized for those in appropriately utilized for those in genuine needgenuine need

Perpetuate the existing Perpetuate the existing treatment-oriented ideology treatment-oriented ideology

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Professional Professional ImplicationImplication Primary medical care = curative care ?Primary medical care = curative care ? What is the positioning of the new What is the positioning of the new

health care system meant for the health care system meant for the community?community?

Is the community guaranteed of a Is the community guaranteed of a holistic primary health care which can holistic primary health care which can transform Hong Kong into a healthy transform Hong Kong into a healthy city?city?

What are the roles & functions of What are the roles & functions of health professionals?health professionals?

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The future health care model should embrace

1.1. A health-conscious population A health-conscious population adopting a healthy lifestyle, adopting a healthy lifestyle, responsible for their own healthresponsible for their own health

2.2. A health care profession that A health care profession that views health promotion and views health promotion and preventive medicine as preventive medicine as priorities, acts professionally priorities, acts professionally and ethicallyand ethically

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The future health care model should embrace3.3. A primary health care system which A primary health care system which

can provide a robust family and can provide a robust family and community medicine service community medicine service affordable by all, emphasized on affordable by all, emphasized on health promotion and preventive health promotion and preventive carecare

4.4. A hospital service network which A hospital service network which can provide emergency and can provide emergency and secondary care within reach of the secondary care within reach of the population in all districtspopulation in all districts

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The future health care model should embrace5. Elderly, long-term and 5. Elderly, long-term and

rehabilitation care services which rehabilitation care services which encourage home care with encourage home care with community outreach and community outreach and professional support, with professional support, with infirmary and hospice care in all infirmary and hospice care in all districts to enhance maintenance districts to enhance maintenance of family supportof family support

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The future health care model should embrace6. The establishment of specialized 6. The establishment of specialized

tertiary centers and hospitals to tertiary centers and hospitals to develop and concentrate develop and concentrate expertise, technology, special expertise, technology, special facilities and research for the facilities and research for the treatment of catastrophic treatment of catastrophic illnessesillnesses

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The future health care model should embrace7. Well-integrated public and 7. Well-integrated public and

private sectors which promote private sectors which promote healthy competition in terms of healthy competition in terms of service quality and professional service quality and professional standards, and provide a choice standards, and provide a choice for the publicfor the public

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The future health care model should embrace8. A financing model which 8. A financing model which

encourages appropriate use of encourages appropriate use of healthcare services, ethical and healthcare services, ethical and effective professional care, effective professional care, reasonable and affordable reasonable and affordable contributions by users, and with contributions by users, and with targeted subsidies through public targeted subsidies through public funds for the most needyfunds for the most needy

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Re-positioning of the Re-positioning of the Public Sector:: Service : A & E careService : A & E care Target : Low income and Target : Low income and

underprivileged groups underprivileged groups Illnesses : high cost, advanced Illnesses : high cost, advanced

technology and multi- technology and multi- disciplinary disciplinary

professional professional team work team work Training of health care professionalsTraining of health care professionals

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Re-positioning of the Re-positioning of the Private Sector:: Provide comprehensive, personal and Provide comprehensive, personal and

quality care quality care Provide choicesProvide choices Provide affordable services to people Provide affordable services to people

of average income levelof average income level Provide attraction to young health care Provide attraction to young health care

professionalsprofessionals Contribute towards professional health Contribute towards professional health

care trainingcare training

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Professional Professional implicationimplication Is it feasible to restructure the Is it feasible to restructure the

medical fee model in private sector medical fee model in private sector in order to make the services in order to make the services affordable to the average income affordable to the average income group ? Who will have the say on the group ? Who will have the say on the fee structure? fee structure?

Who will be responsible to regulate Who will be responsible to regulate & how to regulate the private & how to regulate the private sector?sector?

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Professional Professional implicationimplication The utilization rate of hospital services is The utilization rate of hospital services is

fee/ cost-directed, users will have a better fee/ cost-directed, users will have a better choice only if quality and cost of services choice only if quality and cost of services are justifiably leveled. What will be the are justifiably leveled. What will be the competitive advantages of the private competitive advantages of the private services over the public services so as to services over the public services so as to successfully induce the flow of patients successfully induce the flow of patients from the public to the private sectors?from the public to the private sectors?

How to facilitate the flow of services from How to facilitate the flow of services from the public to the private logistically? the public to the private logistically?

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Professional Professional implicationimplication What do you think about the financing What do you think about the financing

concept of “money goes with the concept of “money goes with the patients”? Does it further imply that the patients”? Does it further imply that the public sector/ government will have to public sector/ government will have to guarantee, for instance, the patient guarantee, for instance, the patient headcounts, as the bargaining chips to headcounts, as the bargaining chips to induce the private sector to lower the induce the private sector to lower the level of their service charges in order to level of their service charges in order to foster a tighter collaboration? foster a tighter collaboration?

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Primary Health Care Primary Health Care ServiceService is to provide continual, is to provide continual,

comprehensive and whole-person comprehensive and whole-person medical care to individuals in their medical care to individuals in their home environmenthome environment

Greater emphasis on prevention Greater emphasis on prevention Promotion of family doctor conceptPromotion of family doctor concept Encourage inter-disciplinary Encourage inter-disciplinary

professional collaboration to tackle professional collaboration to tackle patients’ problems from all anglespatients’ problems from all angles

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Promotion of the Promotion of the Family Doctor ConceptFamily Doctor Concept A continuous relationship with the patieA continuous relationship with the patie

nts, patients’ medical history, lifestyle, nts, patients’ medical history, lifestyle, habits etc.habits etc.

The mindset and training of managing pThe mindset and training of managing problems in a holistic wayroblems in a holistic way

The first point of contact of the patient The first point of contact of the patient The long-term carer of patients with chrThe long-term carer of patients with chr

onic disease in stabilized conditionsonic disease in stabilized conditions

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Professional ImplicationProfessional Implication

How to define family doctor: GP VS SHow to define family doctor: GP VS Specialist ? Who will take the lead?pecialist ? Who will take the lead?

Family doctor as the first point of coFamily doctor as the first point of contact of the patient ? Is it justifiable?ntact of the patient ? Is it justifiable?

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Second Level Hospital Second Level Hospital ServiceService

1.1. District / Regional Based Acute District / Regional Based Acute hospitalization service, taking hospitalization service, taking into consideration population into consideration population characteristics and other characteristics and other relevant factors in its planning relevant factors in its planning

2.2. Promulgation of clearly defined Promulgation of clearly defined indications for use of public indications for use of public hospital resourceshospital resources

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Second Level Hospital Second Level Hospital ServiceService

3. Public sector : Re-focus services 3. Public sector : Re-focus services to to the Four the Four Target Groups Target Groups

Private sector: Take on a more Private sector: Take on a more active active role in role in the provision of the provision of hospital servicehospital service

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Professional implicationProfessional implication

How to initiate private sector to activHow to initiate private sector to actively participate in the service provisioely participate in the service provision? Who will pay for it?n? Who will pay for it?

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Tertiary & Specialized Tertiary & Specialized ServicesServices

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The TrajectoryThe Trajectory

Government-committedGovernment-committed Concentrate expertise, resources Concentrate expertise, resources

& research on catastrophic & research on catastrophic diseasesdiseases

Provide affordable & sustainable Provide affordable & sustainable specialized care to the specialized care to the unfortunate minorityunfortunate minority

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Professional Professional Implication Implication How to access the affordability How to access the affordability

within the community and users within the community and users from different social hierarchies from different social hierarchies with different social needs?with different social needs?

To what extent will the To what extent will the sustainability of the system and sustainability of the system and the service quality improved after the service quality improved after the revamp? the revamp?

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Professional Professional Implication Implication How to balance sustainability and How to balance sustainability and

affordability in real terms? Can we affordability in real terms? Can we achieve a Win-Win situation? What is achieve a Win-Win situation? What is government trying to forgo? government trying to forgo?

What is the financial implication of the What is the financial implication of the revamp on medical financing? revamp on medical financing?

What is the financing model?What is the financing model? Who will be affected positively and Who will be affected positively and

negatively?negatively? Is the revamp itself sustainable at all ? Is the revamp itself sustainable at all ?

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Ways to achieve Ways to achieve

Sources of funding : Sources of funding : Encourage donations to support Encourage donations to support

public & private services & public & private services & researchresearch

Consider a larger patient co-Consider a larger patient co-payment portion with payment portion with reasonable cap to heighten reasonable cap to heighten health awareness of the publichealth awareness of the public

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Professional Professional ImplicationImplication Does the current fee structure impose Does the current fee structure impose

heavy financial burdens on the users heavy financial burdens on the users in the tertiary level? Did the in the tertiary level? Did the administration access?administration access?

To what extent will the larger co-To what extent will the larger co-payment portion further exacerbate payment portion further exacerbate the burden?the burden?

Who would be negatively seriously Who would be negatively seriously affected?affected?

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Professional Professional ImplicationImplication Will the co-payment portion be Will the co-payment portion be

adjusted according to the nature of adjusted according to the nature of diseases and different conditions?diseases and different conditions?

Having considered the financial Having considered the financial ability and situations varies case ability and situations varies case by case, is a reasonable cap by case, is a reasonable cap possible for everyone and does it possible for everyone and does it mean to be a fair say?mean to be a fair say?

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Ways to achieveWays to achieve

Concentration of expertise & services:Concentration of expertise & services:

1.1. Consolidate services in a few Consolidate services in a few designated centers rather than one designated centers rather than one mega center.mega center.

2.2. Work out planning guidelines based Work out planning guidelines based on caseloads & training demand on caseloads & training demand

3.3. Review guidelinesReview guidelines

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Professional Professional implicationimplication Should we make the planning Should we make the planning

guidelines based on caseloads a guidelines based on caseloads a fixity to limit the flexibility of the fixity to limit the flexibility of the system?system?

Any difficulties in making the Any difficulties in making the manpower plan? What manpower plan? What parameters should be parameters should be considered?considered?

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Ways to achieveWays to achieve

Public-Private Collaboration : Public-Private Collaboration : 1.1. Encourage private to develop tertiaEncourage private to develop tertia

ry servicesry services2.2. Engage private sector experienced Engage private sector experienced

doctors to practise on part-time badoctors to practise on part-time basis in public hospitals. sis in public hospitals.

3.3. Encourage collation of relevant datEncourage collation of relevant data for better planning a for better planning

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Professional Professional ImplicationImplication Is there any difficulties for the Is there any difficulties for the

private to develop tertiary private to develop tertiary services in terms of market services in terms of market demand, resources support, demand, resources support, medical capability, technological medical capability, technological hindrance and corporate strategy hindrance and corporate strategy & market-directed ideology? Is it & market-directed ideology? Is it cost-effective for it to invest? cost-effective for it to invest?

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Professional Professional ImplicationImplication What is the initiatives for the private What is the initiatives for the private

experienced doctor to forgo resting texperienced doctor to forgo resting time or higher-paid man hours in privime or higher-paid man hours in private sector and practise in the public ate sector and practise in the public market? market?

Most importantly, what is the role of Most importantly, what is the role of allied health in this respect?allied health in this respect?

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Ways to achieveWays to achieve

Strengthen the role of prevention : Strengthen the role of prevention :

1.1. Develop aggressive prevention Develop aggressive prevention strategy against chronic strategy against chronic catastrophic illness & combinationcatastrophic illness & combination

2.2. Life style modifications, effective Life style modifications, effective vaccination & disease managementvaccination & disease management

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Professional Professional ImplicationImplication Any time-line for the social preventive Any time-line for the social preventive

health care engineering project in spatial health care engineering project in spatial and temporal terms? and temporal terms?

How much resources will be input to fuel How much resources will be input to fuel the projects? What are the size of the projects? What are the size of projects and the monitoring work? Any projects and the monitoring work? Any promises & pledges? Any special task promises & pledges? Any special task force to legislate, administer and force to legislate, administer and monitor?monitor?

Any indicators or indexes to access the Any indicators or indexes to access the progress & social behavioral changes? progress & social behavioral changes?

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Elderly, Long-term & Elderly, Long-term & Rehabilitation Care Rehabilitation Care ServicesServices

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The Trajectory The Trajectory (elderly (elderly services)services) Strengthen on-site regular primary Strengthen on-site regular primary

medical care of Residential Care Homedical care of Residential Care Homes for the Elderly (RCHEs) & the dismes for the Elderly (RCHEs) & the disabled (RCHDs) abled (RCHDs)

Encourage home care & family suppEncourage home care & family support with community outreach & profort with community outreach & professional support in all districts essional support in all districts

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Professional Professional ImplicationImplication Can we access the present Can we access the present

capability of VMO in discharging the capability of VMO in discharging the outreach duties ? Is the VMO in the outreach duties ? Is the VMO in the right conditions to cater the needs right conditions to cater the needs of the elderly homes at present?of the elderly homes at present?

Is the VMOIs the VMO ready to take the job? ready to take the job? Will it help to strengthen the on-site Will it help to strengthen the on-site service?service?

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Ways to achieve Ways to achieve (elderly services)(elderly services)

Strengthen centers’ primary care : Strengthen centers’ primary care : 1.1. Regular medical checks as licensinRegular medical checks as licensin

g requirementg requirement2.2. Tightened collaboration between pTightened collaboration between p

ublic, private hospitals, RCHEs, RCublic, private hospitals, RCHEs, RCHDsHDs

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Professional Professional ImplicationImplication What is the role played by the RCHEs and What is the role played by the RCHEs and

RCHDs to ensure there will not be any abuRCHDs to ensure there will not be any abuse of hospital services, for instance, at timse of hospital services, for instance, at times short of manpower during public holides short of manpower during public holidays?ays?

The role of doctors is emphasized in the fuThe role of doctors is emphasized in the future routine of geriatrics services in the ceture routine of geriatrics services in the centers, what are the roles taken by the nursnters, what are the roles taken by the nurses and other allied health members?es and other allied health members?

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Ways to achieve Ways to achieve (elderly services)(elderly services)

Public sector needs to :Public sector needs to : Re-position Community Geriatric ARe-position Community Geriatric A

ssessment teams ssessment teams Provide discharge plan & support tProvide discharge plan & support t

o doctors of RCHEs o doctors of RCHEs Develop & adopt shared care progrDevelop & adopt shared care progr

ammes & referral protocols with doammes & referral protocols with doctors of RCHEsctors of RCHEs

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Ways to achieve Ways to achieve (elderly services)(elderly services)

Private sector needs to :Private sector needs to :1.1. Offer outreach services to RCHEs & Offer outreach services to RCHEs &

RCHDsRCHDs

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Professional Professional ImplicationImplicationProfessional Implication:Professional Implication: What is the part played by private sector What is the part played by private sector

on community geriatrics in the centers? on community geriatrics in the centers? What are the motivations? If private is What are the motivations? If private is subsidized by the government in these subsidized by the government in these services, what are the justifications? services, what are the justifications? Who will be paying for the private CNS?Who will be paying for the private CNS?

Again, what is the support provided for Again, what is the support provided for the allied health in this respect?the allied health in this respect?

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The Trajectory The Trajectory (Long term & (Long term & rehabilitative services)rehabilitative services) Smooth the interface between Smooth the interface between

hospital, rehabilitative and hospital, rehabilitative and primary medical servicesprimary medical services

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Ways to achieve Ways to achieve (Long term & rehabilitative (Long term & rehabilitative services)services)

The public sector needs to:The public sector needs to: Expand community nursing Expand community nursing

services (CNS) in chronic illness services (CNS) in chronic illness managementmanagement

2. Employ specially trained health 2. Employ specially trained health care workerscare workers

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Professional Professional ImplicationImplication How to do with the blurring of How to do with the blurring of

work boundary of nursing duties?work boundary of nursing duties? Any implication on de-nursing Any implication on de-nursing How to balance the upholding of How to balance the upholding of

nurses’ professional status quo & nurses’ professional status quo & the decision of having labor the decision of having labor division in saving the overloaded division in saving the overloaded system?system?

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Professional Professional ImplicationImplication What are the initiatives for graduates What are the initiatives for graduates

to specialize & dedicate in to specialize & dedicate in community nurses services? Is there community nurses services? Is there any well-planned and well-defined any well-planned and well-defined training programme and demarcation training programme and demarcation of duties for the community nurses? of duties for the community nurses?

What are the roles of the allied What are the roles of the allied health teams in CNS? Any manpower health teams in CNS? Any manpower plan, guidelines, participatory plan, guidelines, participatory concerns raised for the allied team in concerns raised for the allied team in this respect?this respect?

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Ways to achieve Ways to achieve (Long term & rehabilitative (Long term & rehabilitative services)services)

The private & social Welfare The private & social Welfare

sectors needs to :sectors needs to :

1.1. Develop short-stay institutions Develop short-stay institutions providing temporary convalescent providing temporary convalescent & rehabilitative services& rehabilitative services

2.2. Refer deserving cases to CNS Refer deserving cases to CNS

3.3. Set up its own CNS for those Set up its own CNS for those economically capableeconomically capable

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Professional Professional ImplicationImplication How does the transfer of How does the transfer of

patients from tertiary public to patients from tertiary public to private short-stayed private short-stayed rehabilatative made possible, rehabilatative made possible, having considered the different having considered the different fee structures and service fee structures and service targets of the two targets of the two

systems?systems?

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Professional Professional ImplicationImplication What are the initiatives to What are the initiatives to

encourage patients from public encourage patients from public CNS to change to private CNS?CNS to change to private CNS?

Does it make sense for the Does it make sense for the private to set up its own CNS private to set up its own CNS from economic perspectives? from economic perspectives? What are the social obligations What are the social obligations for the private in opening up for the private in opening up CNS?CNS?

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Ways to achieve Ways to achieve (Long term & rehabilitative (Long term & rehabilitative services)services)

Universities & Training institutionsUniversities & Training institutionshave to :have to :1.1. Train health care workers & Train health care workers &

community nurses community nurses 2.2. Should we train the Health Care Should we train the Health Care

Assistants at universities or Assistants at universities or institutions ? Can we reflect on their institutions ? Can we reflect on their present nursing standard and re-present nursing standard and re-position their role of importance in position their role of importance in our future care delivery model? our future care delivery model?

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Professional Professional ImplicationsImplications

While there is no concrete plans While there is no concrete plans and many uncertainties still loom, and many uncertainties still loom, does it make sense to train a bulk does it make sense to train a bulk of community nurses and special of community nurses and special health care workers which may health care workers which may possibly lead to false estimation?possibly lead to false estimation?

Is there any overall HR planning Is there any overall HR planning on Health Professionals ?on Health Professionals ?

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Integration between Integration between the private & public the private & public sectors sectors

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Ways to achieveWays to achieve

Foster the links & protocol between Foster the links & protocol between family doctors, 24-hr district based family doctors, 24-hr district based clinics & the public A&E on the triage clinics & the public A&E on the triage criteria & waiting timecriteria & waiting time

Establish referral protocols & shared-Establish referral protocols & shared-care programme for the care of stable care programme for the care of stable chronic patientschronic patients

Division of work and specialization Division of work and specialization performed on the management of a performed on the management of a specific patientsspecific patients

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THE ENDTHE END