Building a Healthy Tomorrow ?

1. Consultation Meeting on Hong Kong Future Healthcare ModelLegislative Council Health Service Constituency Office of Dr. Hon. Joseph Lee Kok Long 15th September 2005

2. Building a Healthy Tomorrow ? Summary & Fruits for thought of Discussion Paper on the Future Service Delivery Model for our Health Care System

3. Existing Health Care Model • Curative care • Hospital services should be able to provide the best care for patients

4. Future Service Delivery Model • Preventive care and continuity of care • Home and family care play important roles

5. What should our future service delivery model be? • Re-emphasize the importance of primary medical care • Ensure our limited resources appropriately utilized for those in genuine need • Perpetuate the existing treatment-oriented ideology

6. Professional Implication • Primary medical care = curative care ? • What is the positioning of the new health care system meant for the community? • Is the community guaranteed of a holistic primary health care which can transform Hong Kong into a healthy city? • What are the roles & functions of health professionals?

7. The future health care model should embrace • A health-conscious population adopting a healthy lifestyle, responsible for their own health • A health care profession that views health promotion and preventive medicine as priorities, acts professionally and ethically

8. The future health care model should embrace • A primary health care system which can provide a robust family and community medicine service affordable by all, emphasized on health promotion and preventive care • A hospital service network which can provide emergency and secondary care within reach of the population in all districts

9. The future health care model should embrace 5. Elderly, long-term and rehabilitation care services which encourage home care with community outreach and professional support, with infirmary and hospice care in all districts to enhance maintenance of family support

10. The future health care model should embrace 6. The establishment of specialized tertiary centers and hospitals to develop and concentrate expertise, technology, special facilities and research for the treatment of catastrophic illnesses

11. The future health care model should embrace 7. Well-integrated public and private sectors which promote healthy competition in terms of service quality and professional standards, and provide a choice for the public

12. The future health care model should embrace 8. A financing model which encourages appropriate use of healthcare services, ethical and effective professional care, reasonable and affordable contributions by users, and with targeted subsidies through public funds for the most needy

13. Re-positioning of the Public Sector: • Service : A & E care • Target : Low income and underprivileged groups • Illnesses : high cost, advanced technology and multi- disciplinary professional team work • Training of health care professionals

14. Re-positioning of the Private Sector: • Provide comprehensive, personal and quality care • Provide choices • Provide affordable services to people of average income level • Provide attraction to young health care professionals • Contribute towards professional health care training

15. Professional implication • Is it feasible to restructure the medical fee model in private sector in order to make the services affordable to the average income group ? Who will have the say on the fee structure? • Who will be responsible to regulate & how to regulate the private sector?

16. Professional implication • The utilization rate of hospital services is fee/ cost-directed, users will have a better choice only if quality and cost of services are justifiably leveled. What will be the competitive advantages of the private services over the public services so as to successfully induce the flow of patients from the public to the private sectors? • How to facilitate the flow of services from the public to the private logistically?

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

18. Primary Health Care Service • is to provide continual, comprehensive and whole-person medical care to individuals in their home environment • Greater emphasis on prevention • Promotion of family doctor concept • Encourage inter-disciplinary professional collaboration to tackle patients’ problems from all angles

19. Promotion of the Family Doctor Concept • A continuous relationship with the patients, patients’ medical history, lifestyle, habits etc. • The mindset and training of managing problems in a holistic way • The first point of contact of the patient • The long-term carer of patients with chronic disease in stabilized conditions

20. Professional Implication • How to define family doctor: GP VS Specialist ? Who will take the lead? • Family doctor as the first point of contact of the patient ? Is it justifiable?

21. Second Level Hospital Service • District / Regional Based Acute hospitalization service, taking into consideration population characteristics and other relevant factors in its planning • Promulgation of clearly defined indications for use of public hospital resources

22. Second Level Hospital Service 3. Public sector : Re-focus services to the Four Target Groups Private sector: Take on a more active role in the provision of hospital service

23. Professional implication • How to initiate private sector to actively participate in the service provision? Who will pay for it?

24. Tertiary & Specialized Services

25. The Trajectory • Government-committed • Concentrate expertise, resources & research on catastrophic diseases • Provide affordable & sustainable specialized care to the unfortunate minority

26. Professional Implication • How to access the affordability within the community and users from different social hierarchies with different social needs? • To what extent will the sustainability of the system and the service quality improved after the revamp?

27. Professional Implication • How to balance sustainability and affordability in real terms? Can we achieve a Win-Win situation? What is government trying to forgo? • What is the financial implication of the revamp on medical financing? • What is the financing model? • Who will be affected positively and negatively? • Is the revamp itself sustainable at all ?

28. Ways to achieve Sources of funding : • Encourage donations to support public & private services & research • Consider a larger patient co-payment portion with reasonable cap to heighten health awareness of the public

29. Professional Implication • Does the current fee structure impose heavy financial burdens on the users in the tertiary level? Did the administration access? • To what extent will the larger co-payment portion further exacerbate the burden? • Who would be negatively seriously affected?

30. Professional Implication • Will the co-payment portion be adjusted according to the nature of diseases and different conditions? • Having considered the financial ability and situations varies case by case, is a reasonable cap possible for everyone and does it mean to be a fair say?

31. Ways to achieve Concentration of expertise & services: • Consolidate services in a few designated centers rather than one mega center. • Work out planning guidelines based on caseloads & training demand • Review guidelines

32. Professional implication • Should we make the planning guidelines based on caseloads a fixity to limit the flexibility of the system? • Any difficulties in making the manpower plan? What parameters should be considered?

33. Ways to achieve Public-Private Collaboration : • Encourage private to develop tertiary services • Engage private sector experienced doctors to practise on part-time basis in public hospitals. • Encourage collation of relevant data for better planning

34. Professional Implication • Is there any difficulties for the private to develop tertiary services in terms of market demand, resources support, medical capability, technological hindrance and corporate strategy & market-directed ideology? Is it cost-effective for it to invest?

35. Professional Implication • What is the initiatives for the private experienced doctor to forgo resting time or higher-paid man hours in private sector and practise in the public market? • Most importantly, what is the role of allied health in this respect?

36. Ways to achieve Strengthen the role of prevention : • Develop aggressive prevention strategy against chronic catastrophic illness & combination • Life style modifications, effective vaccination & disease management

37. Professional Implication • Any time-line for the social preventive health care engineering project in spatial and temporal terms? • How much resources will be input to fuel the projects? What are the size of projects and the monitoring work? Any promises & pledges? Any special task force to legislate, administer and monitor? • Any indicators or indexes to access the progress & social behavioral changes?

38. Elderly, Long-term & Rehabilitation Care Services

39. The Trajectory (elderly services) • Strengthen on-site regular primary medical care of Residential Care Homes for the Elderly (RCHEs) & the disabled (RCHDs) • Encourage home care & family support with community outreach & professional support in all districts

40. Professional Implication • Can we access the present capability of VMO in discharging the outreach duties ? Is the VMO in the right conditions to cater the needs of the elderly homes at present? • Is the VMOready to take the job? Will it help to strengthen the on-site service?

41. Ways to achieve (elderly services) Strengthen centers’ primary care : • Regular medical checks as licensing requirement • Tightened collaboration between public, private hospitals, RCHEs, RCHDs

42. Professional Implication • What is the role played by the RCHEs and RCHDs to ensure there will not be any abuse of hospital services, for instance, at times short of manpower during public holidays? • The role of doctors is emphasized in the future routine of geriatrics services in the centers, what are the roles taken by the nurses and other allied health members?

43. Ways to achieve (elderly services) Public sector needs to : • Re-position Community Geriatric Assessment teams • Provide discharge plan & support to doctors of RCHEs • Develop & adopt shared care programmes & referral protocols with doctors of RCHEs

44. Ways to achieve (elderly services) Private sector needs to : • Offer outreach services to RCHEs & RCHDs

45. Professional Implication Professional Implication: • What is the part played by private sector on community geriatrics in the centers? What are the motivations? If private is subsidized by the government in these services, what are the justifications? Who will be paying for the private CNS? • Again, what is the support provided for the allied health in this respect?

46. The Trajectory (Long term & rehabilitative services) • Smooth the interface between hospital, rehabilitative and primary medical services

47. Ways to achieve (Long term & rehabilitative services) The public sector needs to: • Expand community nursing services (CNS) in chronic illness management 2. Employ specially trained health care workers

48. Professional Implication • How to do with the blurring of work boundary of nursing duties? • Any implication on de-nursing • How to balance the upholding of nurses’ professional status quo & the decision of having labor division in saving the overloaded system?

49. Professional Implication • What are the initiatives for graduates to specialize & dedicate in community nurses services? Is there any well-planned and well-defined training programme and demarcation of duties for the community nurses? • What are the roles of the allied health teams in CNS? Any manpower plan, guidelines, participatory concerns raised for the allied team in this respect?

50. Ways to achieve (Long term & rehabilitative services) The private & social Welfare sectors needs to : • Develop short-stay institutions providing temporary convalescent & rehabilitative services • Refer deserving cases to CNS • Set up its own CNS for those economically capable