Integrating Public Health Approaches to Primary Care in Hong Kong

There is wide agreement that healthcare reform in Hong Kong is necessary. The population is aging, the patterns of disease reflect growing affluence and longevity, more sophisticated medical techniques and treatments which are pushing new boundaries in saving and prolonging lives- and costs are going up. However, there is poor understanding of the burden of non communicable disease and whether effective evidence based care is being provided to the community in a consistent manner. International literature shows that modern healthcare systems need to be based on primary care , and on evidence based guidance which places emphasis on prevention of non communicable diseases in order to decrease the burden of avoidable morbidity and mortality. Although guidelines for treatment of common diseases such as hypertension and diabetes existed in Hong Kong they were fragmented between organizations and groups of the population, were not necessarily available to the public and not shared with others involved in the process of providing care. Doctor shopping patients received a wide variety of often unnecessary interventions and the majority of primary care is provided by the private practitioners working in isolation.

Recognising the need for population wide evidence based guidance which was feasible and acceptable to all in the healthcare system and to the workforce in public and private sectors, the government has produced reference frameworks for diabetes and hypertension [http://www.fhb.gov.hk] through a multi-disciplinary and integrated care approach which was adopted to build professional consensus and promote greater understanding and engagement amongst the public .

This paper will describe the process of consensus building to produce the reference frameworks, the problems faced in introducing them into a system in which the majority of primary care is paid for out of pocket and the gap between rhetoric and reality.