Draft:Primary Healthcare Office

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Formerly the Primary Care Office, the Primary Healthcare Office (PHO) was established under the former Food and Health Bureau to monitor and regulate the development of primary healthcare services.[1]

Primary Healthcare Office
基層醫療健康辦事處
Agency overview
Formed1 March 2019; 5 years ago (2019-03-01)
JurisdictionGovernment of Hong Kong SAR
Agency executive
  • Dr Pang Fei Chau, Commissioner for Primary Healthcare
Parent departmentHealth Bureau
Websitehttps://www.healthbureau.gov.hk/pho/main/home_page.html?lang=2

Background Information[edit]

Historical Development[2]

  • 2008: The Government published the Consultation Document on Healthcare Reform "Your Health, Your Life", proposing a collective package of reforms of the healthcare system, including the provision of continual, preventive, comprehensive and holistic healthcare services in enhancing the primary healthcare system.
  • 2010:
    • The Government published the "Primary Care Development in Hong Kong: Strategy Document", outlining the major strategies and directions of optimising the quality of delivering primary care services in Hong Kong.
    • The Primary Care Office (the original form of PHO) was established under the Department of Health (DH) to support the former Food and Health Bureau in enacting strategies to strengthen the delivery of primary care service.
  • 2017: The Steering Committee on Primary Healthcare Development was formed in November to carry out a complete review of the existing design of providing primary healthcare services and develop a blueprint for the sustainable expansion and improvement of primary healthcare services in Hong Kong.
  • 2019:
    • The Primary Healthcare Office (PHO) was set up under the former Food and Health Bureau, under the leadership of a Principal assistant secretary from the Bureau.
    • The former Primary Care Office was integrated with the PHO on 1 October 2019.

Primary Goals[3]

The primary goals of the PHO include:

  1. To develop District Health Centres (DHCs) on a novel, district-based mode of operation which fosters public-private partnerships and medical-social collaborations in providing primary healthcare service;
  2. To strengthen multidisciplinary, cross-sectoral and inter-organisational co-ordination in primary healthcare;
  3. To develop, update and promulgate the reference frameworks for primary care setting;
  4. To manage and promote the use of the Primary Care Directory;
  5. To promote primary care, the concepts of family doctors and family medicine.

Structure[4]

Reporting to the Permanent Secretary for Health, the leadership of the Primary Healthcare Office includes:

  • Commissioner for Primary Healthcare (formerly led by a principal assistant secretary from the Bureau)
  • Assistant Commissioners for Primary Healthcare
  • Senior Medical & Health Officer (PHO)
  • Associate Consultant (PHO)

Relations with Primary Healthcare Blueprint

In light of the challenges of the rapidly ageing population and increasing prevalence of chronic diseases, the Primary Healthcare Blueprint is published as a strategic proposal which aims to create a primary healthcare system that sustainably improves all aspects of public health and hence the quality of life for the population.[5]

PHO is a part of the Primary Healthcare Blueprint to improve the current health governance structure by placing a greater emphasis on primary healthcare. It is proposed to gradually transform the PHO into the Primary Healthcare Commission so as to resolve imbalances among different levels of healthcare within policy-making, resources and manpower allocation, regulation and performance control. It is also expected to implement institutional changes and strengthen coordination among subordinates in delivering services.[6]

Objectives[edit]

Development of District Health Centres[edit]

As announced in the Chief Executive's 2017 Policy Address in October 2017, the current-term Government is determined to step up efforts to promote individual and community involvement, enhance co-ordination among various medical and social sectors, and strengthen district-level primary healthcare services. The aim of these measures is to encourage the public to take precautionary measures against diseases, enhance their capability in self-care and home care, and reduce the demand for hospitalization. The setting up of DHCs is one of the initiatives in this regard.

Chaired by the Secretary for Food and Health, the Steering Committee on Primary Healthcare Development was set up in November 2017 to develop a blueprint for the sustainable development of primary healthcare services for Hong Kong. It will comprehensively review the existing planning of primary healthcare services and devise service models to provide primary healthcare services via district-based medical-social collaboration in the community. The Steering Committee is underpinned by a Working Group on District Health Centre Pilot Project in Kwai Tsing District to provide advice on the planning, implementation and evaluation of the Pilot Project. The Primary Healthcare Office was established under the Food and Health Bureau ("FHB") in March 2019 to oversee the development of primary healthcare services at the bureau level.[7]

Reference Frameworks for Primary Care Setting:[edit]

The Reference Frameworks provide common reference to primary health care professionals to facilitate the provision of continuing, comprehensive and evidence-based care in the community. They also help family doctors disseminate health promotion messages to the public, as well as empower patients and carers in management of health.

Six Reference Frameworks, comprising core documents and modules on some important topics about preventive care and disease management, have been published.[8]

Use of the Primary Care Directory[9][edit]

Primary care is the first point of contact in a continuing healthcare process. To enhance primary care especially the provision of continuing, preventive, comprehensive and holistic healthcare services, the Government announced several initiatives including the establishment of a primary care register based on family doctor concept in the 2008-2009 Policy Address.

Based on the recommendations by the Working Group on Primary Care and its Task Force on Primary Care Directory (the Task Force), the Government announced the establishment of Primary Care Directory (the Directory), as well as other strategies and actions for improving the delivery of primary care services, as set out in the "Primary Care Development in Hong Kong: Strategy Document" released in 2010.

The objective of the Directory is to provide the public and healthcare service providers an easily accessible electronic database containing practice information and professional qualification of primary care providers of various disciplines in the community.

The Directory was first launched in April 2011 with sub-directories for doctors and dentists; followed by the sub-directory for Chinese medicine practitioners which was launched in October 2012.

In 2016, the Advisory Committee on Primary Care Directory was established to provide advice on the continual development and maintenance of the Directory.

Development[edit]

District Health Centre

District Health Centre was first proposed in Carrie Lam's first Policy Address in 2017 and piloted in Kwai Tsing District in 2018.[10] All holders of Hong Kong identity card who agree to be enroled in the electronic Health Record Sharing System are eligible for the services provided by the District Health Centre.

"To further illustrate the effectiveness of medical‑social collaboration, I have asked the Food and Health Bureau to set up a district health centre with a brand new operation mode in Kwai Tsing District within two years. The Government will provide funding for the centre according to the needs and characteristics of the district, with a view to enhancing public awareness of disease prevention and their capability in self‑management of health through public‑private partnership, providing support for the chronically ill as well as relieving the pressure on specialist and hospital services."[11]

Nowadays, district health centre acts as a service and resource hub for the general public. It provides health promotion in forms of Health Day, which could include talks hosted by doctors, nurses, dieticians, Chinese Medicine practitioners, and other allied health professionals to promote key health messages. In these events or at the district health centres, there are also services for health screening and disease prevention. Blood pressure monitoring, blood glucose checking, and eye screening examinations are provided from time to time. For the chronically ill population, the district health centres provides information on how they could better manage their chronic illnesses, such as hypertension and diabetes, and provide rehabilitation support.[12]

Currently there are district health centres in seven districts, namely Kwai Tsing, Sham Shui Po, Southern, Tsuen Wan, Tuen Mun, Wong Tai Sin, and Yuen Long Districts. The Primary Healthcare Office identifies a non-governmental organisation through open tender to operate one core centre and several satellite centres, also known as District Health Express, in each district. These non-governmental organisations include The Lok Sin Tong Benevolent Society Kowloon, Yan Chai Hospital, and the Hong Kong Jockey Club Charities Trust.[13] District Health Centres operate independently but are oversought by a DHC Governing Committee, in which the Primary Healthcare Office steers the general direction of the activities held by the District Health Centres.[14]

Primary Care Directory

Primary Care Directory is a web-based electronic database that was launched in April 2011 for doctors and dentists, and was subsequently expanded to Chinese Medicine practitioners in October 2012. Its purpose is to provide the public with an easily accessible platform to search for primary care providers such as doctors, dentists, and Chinese medicine practitioners in their community. The directory also includes information on various community services offered by medical centres and non-governmental organisations (NGOs).[15]

In order to be listed in the Primary Care Directory, healthcare providers must meet specific requirements. Registered doctors, dentists and practising Chinese medicine practitioners (CMPs) in Hong Kong who are committed to providing directly accessible, comprehensive, continuing, co-ordinated and person-centred primary care services are eligible for enrolment in the Directory. They are also encouraged to participate in government-subsidized programs such as the Vaccination Subsidy Scheme, Residential Care Home Vaccination Programme, District Health Centre services, and the Chronic Disease Co-Care Pilot Scheme. As of the current development stage, the Primary Care Directory contains over 5,000 records for doctors. This comprehensive database aims to facilitate the public in finding suitable healthcare professionals and accessing essential healthcare services.[16]

The Primary Care Directory plays a crucial role in promoting transparency and improving access to primary care services in the community. By providing a centralized platform for healthcare information, it enhances the efficiency of healthcare-seeking processes for individuals seeking primary care providers and related community services.

Chronic Disease Co-Care Pilot Scheme (CDCC Pilot Scheme)[17]

The Chronic Disease Co-Care Pilot Scheme (CDCC Pilot Scheme) was launched on 13 November 2023 with the aim of promoting better management of chronic diseases. The scheme focuses on screening for prediabetes, diabetes mellitus (DM), and hypertension (HT). Eligible participants will receive subsidies from the Government to undergo screening by a family doctor of their own choice and subsequent follow up visits by the same family doctor.

Under the CDCC Pilot Scheme, the District Health Centre (DHC) and District Health Centre Extension (DHCE) will collaborate with family doctors to provide follow-up and coordinate health management plans for the participants. This collaboration ensures that participants receive comprehensive and personalised care. All Hong Kong residents aged 45 or above with a Hong Kong Identity Card and no known history of diabetes mellitus or hypertension are eligible for the CDCC Pilot Scheme. They must first visit a District Health Centre or a District Health Centre Express to register as a member and enrol in the electronic Health Record Sharing System. They may then proceed to choose to enrol in the CDCC Pilot Scheme at no costs and choose their own family doctor registered for the Scheme.[18] The staff of DHC / DHC Express will provide a list of eligible doctors for Scheme Participant to select as his/her Family Doctor. After successful pairing, Scheme Participants will be arranged to receive screening and treatment by the self-selected Family Doctor.[19]

Under the CDCC Pilot Scheme, the government will provide each participant a one off $196 subsidy for the screening procedure and the copayment amount by the participant is fixed at $120. For each subsequent consultation session, the government will provide each participant for each session a partial subsidy of $166 and recommend that the doctors participating in the scheme to charge a copayment amount from the patient a sum of $150. Despite the recommendation, the highest copayment can be as high as $800.[20] When the use of drugs is warranted, drugs stipulated in the list of Specified Drugs are free of any extra charge while the costs to use other drugs are borne by the participant. The government will also provide partial subsidy for laboratory investigation such as blood test and nurse clinic and allied health professional visits.[21]

To incentivise participation and continued engagement, the scheme offers a $150 fee reduction for the first subsidised consultation in the following program year after achieving the incentive targets. This encourages participants to remain proactive in managing their chronic conditions and maintaining regular contact with their family doctors.

The CDCC Pilot Scheme has also shown positive progress in terms of registration and participation. As of 17 November, approximately 3,600 individuals have registered for the scheme. Among them, around 1,000 have successfully partnered with a family doctor.[22] This indicates a strong interest and willingness from the public to actively participate in the programme.

Furthermore, the scheme has garnered support from the medical community, with 447 family doctors joining the initiative as of 24 November.[22] This demonstrates the commitment of healthcare professionals to enhance the management and care of chronic diseases in collaboration with the government and community health centers.

The CDCC Pilot Scheme is part of a broader effort to improve public health and promote better management of chronic diseases.

Controversies[edit]

Ambiguous Position[23]

Former Vice Chairperson of Tuen Mun District Council, former member of the Working Group on Medical and Rehabilitation Services, and former legislator Mr Lemon Wong, observed the lack of promotion and hence use rates of DHCs. He explained that it showed the low public awareness and hence the effectiveness of preventive healthcare. He then criticised the PHO for having an ambiguous position and potentially being a redundant part of the entire blueprint of Primary Healthcare. He advised having the Health Bureau and Social Welfare Department involved in coordinating the distribution of resources to effectively improve primary health by achieving collaboration between the healthcare system and the social welfare system.

Mr Anthony Lai, Community Development Manager of Health in Action, commented on the work of PHO. Although it was anticipated that the PHO would coordinate the administration of both public and private primary healthcare and set standards for its subsidiary DHCs, Lai contended the PHO should make clear its values and directions of development, or else citizens would be lax in taking preventive healthcare measures.

Fragmented Coordination[24]

It was noted in a 2022 Audit Report that the Government recognised that the current primary healthcare system lacked a holistic strategy, resulting in inefficient use of resources and misalignment of incentives. It therefore proposed transforming PHO into an overarching governing body (i.e. the Primary Healthcare Authority) to oversee primary healthcare services, review and realign the roles of different key service providers, as well as to enhance cross-sectoral and inter-organisational coordination. For instance, to avoid service duplication, certain Department of Health’s primary healthcare functions (e.g. elderly health services and cancer prevention, fall prevention or nutrition classes) would be gradually integrated into DHCs. The Health Bureau also proposed to offer DHCs as an alternative option for elders who are on the waiting list and wish to enrol as new members of the Elderly Health Centres. The Audit suggested the Health Bureau continue exploring ways to enhance the collaboration among DHCs and other primary healthcare service providers in the delivery of primary healthcare services.

Ineffective and Lax Monitoring of DHC

The PHO is responsible for monitoring the performance of DHCs. However, The Audit Report in 2022 showed that PHO failed to maintain service targets. For instance, the operator of Kwai Tsing DHC had failed to meet all proposed service outputs in its first year of operation as the PHO required staff members of the DHC to cease or limit face-to-face and walk-in services to reduce the risk of community transmission; and take up additional tasks to fight against the epidemic (e.g. operated as a vaccination centre). The situation had improved for the subsequent years, but 4 of the 9 targets were still under-achieved in 2021-22.[25]

Also, the PHO did not observe the inconsistency in standards. The contracts awarded in April 2021 stipulated that if the calculated overall performance was lower than the yearly agreed service output targets, the Government had the right to deduct a percentage of an instalment payment. However, similar clauses were not included in the service contracts for the full-fledged DHCs, such as the Tsuen Wan DHC.[26]

Moreover, PHO had yet to take timely actions after inspections. PHO is obliged to provide an inspection summary to operators after a service or financial inspection, but for the 4 financial inspections to Kwai Tsing DHC, PHO took a range from 82 to 385 days to issue inspection summaries to the operator.[27]

Unclear Guidelines to DHCs and DHCEs[28]

PHO has issued DHC Manual to operators to ensure service quality and consistency. However, it was criticised that there were discrepancies in guidelines for DHCs and DHCEs, in which the DHCs were provided detailed operation procedures while DHCEs were not.

Inadequate Information in PHO’s Website[29]

PHO’s promotional one-stop website has not provided information about DHC’s satellite centres and DHCEs’ service points. The dedicated website of Tuen Mun DHC was not set up, and subsequently, its service information was not included as of 31 July 2022 (it is available as of 3 December 2023).

References[edit]

  1. ^ About Us. Primary Healthcare Office. Health Bureau. https://www.healthbureau.gov.hk/pho/main/about_us.html?lang=2. Accessed 16 December 2023.
  2. ^ Background of Primary Care Development. Primary Healthcare Office. Health Bureau. https://www.healthbureau.gov.hk/pho/main/background_of_primary_care_development.html?lang=2. Accessed 16 December 2022.
  3. ^ Ibid1
  4. ^ Primary Healthcare Office. Government Telephone Directory. https://tel.directory.gov.hk/0606008855_ENG.html. Accessed 16 December 2023.
  5. ^ Primary Healthcare Blueprint. Health Bureau. https://www.primaryhealthcare.gov.hk/bp/en/. Accessed 16 December 2023.
  6. ^ Primary Healthcare Blueprint. Health Bureau. pp.23 https://www.primaryhealthcare.gov.hk/bp/cms-assets/Primary_Healthcare_Blueprint_Saddle_Stitch_Eng_a1acc40d18.pdf. Accessed 16 December 2023.
  7. ^ Legislative Council (13 November 2020). "LC Paper No. CB(2)191/20-21(04)" (PDF). Retrieved 21 November 2023.
  8. ^ www.healthbureau.gov.hk https://www.healthbureau.gov.hk/pho/main/frameworks.html?lang=2. Retrieved 2023-12-16. {{cite web}}: Missing or empty |title= (help)
  9. ^ www.pcdirectory.gov.hk https://www.pcdirectory.gov.hk/main/about_directory.html?lang=2. Retrieved 2023-12-16. {{cite web}}: Missing or empty |title= (help)
  10. ^ Bureau (www.healthbureau.gov.hk), Health. "Home - District Health Centre Website". www.dhc.gov.hk. Retrieved 2023-12-16.
  11. ^ "The Chief Executive's 2017 Policy Address - Policy Address". www.policyaddress.gov.hk. Retrieved 2023-12-16.
  12. ^ Bureau (www.healthbureau.gov.hk), Health. "Home - District Health Centre Website". www.dhc.gov.hk. Retrieved 2023-12-16.
  13. ^ Bureau (www.healthbureau.gov.hk), Health. "Home - District Health Centre Website". www.dhc.gov.hk. Retrieved 2023-12-16.
  14. ^ Bureau (www.healthbureau.gov.hk), Health. "Home - District Health Centre Website". www.dhc.gov.hk. Retrieved 2023-12-16.
  15. ^ www.pcdirectory.gov.hk https://www.pcdirectory.gov.hk/main/about_directory.html?lang=2. Retrieved 2023-12-16. {{cite web}}: Missing or empty |title= (help)
  16. ^ Health Bureau (October 2023). "Frequently Asked Questions and Answers on Primary Care Directory for Public" (PDF). Retrieved 2023-12-16.
  17. ^ "Introduction of CDCC Pilot Scheme". www.primaryhealthcare.gov.hk. Retrieved 2023-12-16.
  18. ^ "Eligibility". www.primaryhealthcare.gov.hk. Retrieved 2023-12-16.
  19. ^ "Family Doctor Pairing Method". www.primaryhealthcare.gov.hk. Retrieved 2023-12-16.
  20. ^ 香港經濟日報HKET. "【慢病共治計劃】即睇各區335名醫生名單 有中西區醫生索價800元「共付」金額 - 香港經濟日報 - TOPick - 新聞 - 社會". 香港經濟日報HKET (in Traditional Chinese). Retrieved 2023-12-16.
  21. ^ "Subsidy & Co-Payment". www.primaryhealthcare.gov.hk. Retrieved 2023-12-16.
  22. ^ a b 星島日報 (2023-11-18). "「慢病共治計劃」推出首周反應較預期為好 約一千人成功配對". std.stheadline.com (in Chinese). Retrieved 2023-12-16.
  23. ^ 黃舜煬. 基層醫健局‧ 下｜配套不足　動員有限　康健中心獨力難支. HKO1. 23 October 2023. https://www.hk01.com/深度報道/827612/基層醫健局-下-配套不足-動員有限-康健中心獨力難支. Accessed 3 December 2023.
  24. ^ Health Bureau District Health Centre Scheme. Audit Commission. 27 October 2022. Chapter 2, Report No. 79 pp. 78. https://www.aud.gov.hk/pdf_e/e79ch02.pdf. Accessed 3 December 2023.
  25. ^ Health Bureau District Health Centre Scheme. Audit Commission. 27 October 2022. Chapter 2, Report No. 79 pp. 18-22. https://www.aud.gov.hk/pdf_e/e79ch02.pdf. Accessed 3 December 2023.
  26. ^ Health Bureau District Health Centre Scheme. Audit Commission. 27 October 2022. Chapter 2, Report No. 79 pp. 22. https://www.aud.gov.hk/pdf_e/e79ch02.pdf. Accessed 3 December 2023.
  27. ^ Health Bureau District Health Centre Scheme. Audit Commission. 27 October 2022. Chapter 2, Report No. 79 pp. 39. https://www.aud.gov.hk/pdf_e/e79ch02.pdf. Accessed 3 December 2023.
  28. ^ Health Bureau District Health Centre Scheme. Audit Commission. 27 October 2022. Chapter 2, Report No. 79 pp. 72. https://www.aud.gov.hk/pdf_e/e79ch02.pdf. Accessed 3 December 2023.
  29. ^ Health Bureau District Health Centre Scheme. Audit Commission. 27 October 2022. Chapter 2, Report No. 79 pp. 73-74. https://www.aud.gov.hk/pdf_e/e79ch02.pdf. Accessed 3 December 2023.
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