Hong Kong's medical infrastructure consists of a mixed medical economy, with 12 private hospitals and 43 public hospitals. Hong Kong has high standards of medical practice. It has contributed to the development of liver transplantation, being the first in the world to carry out an adult to adult live donor liver transplant in 1993. Both public and private hospitals in Hong Kong have partnered with the Australian Council on Healthcare Standards (ACHS) for international healthcare accreditation. There are also polyclinics that offer primary care services, including dentistry.
The Li Ka Shing Faculty of Medicine of the University of Hong Kong and Faculty of Medicine of The Chinese University of Hong Kong are the two major tertiary institutions nurturing medical professionals in Hong Kong. Every year, over 200 medical undergraduates complete their studies and join the medical workforce. For postgraduate medical education, The Hong Kong Academy of Medicine is an independent institution with the statutory power to organise, monitor, assess and accredit all medical specialist training and to oversee the provision of continuing medical education in Hong Kong. In addition, The Royal College of Physicians and Surgeons of Canada has also accredited the postgraduate medical education (1994–present) in Hong Kong and allowed these graduates from the Hong Kong Academy of Medicine seeking RCPSC Certification and practising in Canada.
A study published in 2016 found that around 8% of the population had avoided seeing a doctor because they couldn't afford to.
Staffing Hong Kong has about 1.9 doctors per 1000 people, which is the same ratio as in Taiwan. Of the over 14,600 doctors in Hong Kong, about 60% work in private practice and the remaining 40% work in the public service. The majority of doctors in Hong Kong, graduated from one of the 2 local medical schools. There are over 1,200 doctors in Hong Kong that graduated from medical schools outside of Hong Kong and passed the rigorous Hong Kong licensing requirements including an examination. These doctors, represented by the Licentiate Society, are known as Licentiates of the Medical Council of Hong Kong (LMCHK). In addition, there are a few hundred colonial doctors; a legacy of the pre-1997 era in which said doctors graduated from medical schools of Commonwealth origin and were automatically given full registration to practice. There are over 7400 registered practitioners of Traditional Chinese medicine.
Public healthcare Subsidised treatment, with small co-payments, is available to people with a Hong Kong identity card and to resident children under the age of 11. Between 2007 and 2011 public spending on healthcare increased by 30%. In 2014/5, it was about 17% of all government expenditure. Emergency medical services, used by around 2.2 million each year, costs HK$400 per patient since January 2026.
Hospital Authority
The Hospital Authority is a statutory body established on 1 December 1990 under the Hospital Authority Ordinance to manage all 42 public hospitals and institutions in Hong Kong. It is mainly responsible for delivering a comprehensive range of secondary and tertiary specialist care and medical rehabilitation through its network of health care facilities. The Authority also provides some primary medical services in 74 primary care clinics.
Hong Kong has only two comprehensive medical faculties, the Li Ka Shing Faculty of Medicine, University of Hong Kong and the Faculty of Medicine, Chinese University of Hong Kong, and they are also the sole two institutes offering medical and pharmacy programs. Other healthcare discipline programs are dispersed among some other universities which do not host a medical faculty.
Private healthcare There are 12 private hospitals in Hong Kong. The government has proposed a Voluntary Health Insurance Scheme in order to encourage more use of the private sector.
Voluntary Health Insurance Scheme (VHIS)
Background The Voluntary Health Insurance Scheme (VHIS) is one of the major medical healthcare reforms proposed by the government. In Hong Kong, the public and private sectors complement each other under a well-established dual-track healthcare system. However, there is an increasing imbalance between the two sectors. Public hospitals take up more than 88% of in-patient services with heavy government subsidies.Legislative council. (2016). Background brief prepared by the Legislative Council Secretariat for the meeting on 19 April 2016 on Voluntary Health Insurance Scheme. Retrieved from
http://www.legco.gov.hk/yr1516/english/panels/hs/hs_hps/papers/hs_hps20160419cb2-1314-2-e.pdf Due to aging population, the rising demand of citizens on good quality healthcare service provision and escalating medical costs, the recurrent expenditure of the government on medical and health care services increased continuously, from $32 billion in 2007 to $52 billion in 2014.Information Services Department. (2014). Government launches public consultation on Voluntary Health Insurance Scheme. Retrieved from
http://www.info.gov.hk/gia/general/201412/15/P201412150257.htm With such huge demand on public medical services, the quality of healthcare provided would inevitably be affected by the heavy workload of the medical staff and proportionally less medical resources per person. Thus, the government proposed the VHIS to recalibrate the balance between public and private healthcare systems by encouraging more well-off citizens, especially the middle-class, to use the private healthcare services as an alternative. Thus, the public sector can focus on providing services in its target areas, thereby enhancing the long-term sustainability of the dual-track healthcare system.
The scheme requires the insurance companies to fulfill 12 minimum requirements and private hospitals to disclose the charges of common medical procedures so as to increase transparency and enhance customers' protection.Food and Health Bureau. (2014b). Voluntary Health Insurance Scheme Public Consultation. Retrieved from http://www.vhis.gov.hk/en/consultation_document/index.html. The government has pointed out that this scheme is not intended as a wholesome solution to the existing problems, but just one of the measures to take forward the reform.Food and Health Bureau. (2014b). Voluntary Health Insurance Scheme Public Consultation. Retrieved from http://www.vhis.gov.hk/en/consultation_document/index.html. The VHIS has already undergone three stages of public consultation since 2008. It will be launched earliest by 2017 if consensus can be reached among the public.
Policy Development Process
The Harvard Report (1999)
Source:The Harvard Team. (1999). Improving Hong Kong's Healthcare System: Why and for Whom? Retrieved from http://www.fhb.gov.hk/en/press_and_publications/consultation/HCS.HTM.
The Health and Welfare Bureau (predecessor of the Food and Health Bureau (FHB)) appointed scholars from the Harvard University to conduct a research on the financing and organisation of health care in Hong Kong. A report titled "Improving Hong Kong's Healthcare System: Why and for Whom?" was published. While they suggested that Hong Kong had an equitable and efficient healthcare system, there was insufficient oversight on the system. The report also raised doubt on the long-term financial sustainability of the system. The report suggested that, in the short run, the government should adopt a two-tier mandatory health insurance scheme consisting of the "Savings Account for Long Term Care (MEDISAGE)" and "Health Security Plan (HSP)", which require both employers' and employees' contribution. Also, the "Competitive Integrated Health Care Option" should be adopted in the long run. It refers to the establishment of a Health Security Fund to pay a standard payment rate to public or private healthcare provider chosen by a patient, thereby realising the principle of 'money follows the patient'. Under the plan, Government funding would not automatically go to the public health sector.
Consultation was conducted alongside the publication of the Harvard Report. But it was shelved due to public resentment.
Consultation: The Life Long Investment Document (2000) The document rejected the HSP proposed by the Harvard Report. A mandatory medical savings scheme called Health Protection Accounts (HPA). The proposal requires individuals aged 40 to 64 to contribute 1 to 2 percent of his earnings to a personal account to cover both the individual and his/her spouse's medical expenses after retirement. However, this consultation was also shelved due to public resentment.Health and Welfare Bureau. Lifelong investment in health consultation document on healthcare reform. Hong Kong: Government of the Hong Kong Special Administrative Region; 2000.
Discussion paper "Building a Healthy Tomorrow" (2005) The discussion paper was issued by the Health and Medical Development Advisory Committee (HMDAC). Recommendations on different aspects of the future service delivery model were made. It foretells that the Advisory Committee will proceed with discussion on the possible financing options and will bring forth relevant recommendation early 2006.Health and Medical Development Advisory Committee. (2005). Building a Healthy Tomorrow: Discussion Paper on the Future Service Delivery Model for our Health Care System. Retrieved from http://www.info.gov.hk/archive/consult/2005/hmdac_paper_e.pdf
First Stage Public Consultation on Health care Reform: 'Your Health Your Life' (2008) Based on the recommendations by the HMDAC, the government conducted the first consultation on healthcare reform in March to June 2008. The three-month consultation aimed at collecting public views on general health care reform in two areas. First, the four service reform proposals, namely (i) enhance primary care; (ii) promote public-private partnership; (iii) develop electronic health record sharing; and (iv) strengthen public healthcare safety net. Second, the six possible supplementary healthcare financing options, including (i) social health insurance; (ii) out-of-pocket payments; (iii) medical savings accounts; (iv) voluntary private health insurance; (v) mandatory private health insurance; and (vi) personal healthcare reserve (a combination of (iii) and (v)). Some pros and cons of the six proposals, and the underlying societal values they represent were spelt out, with the aim to assist the public in their expression of preferences.Food and Health Bureau. (2008). Your Health, Your Life: Healthcare Reform Consultation Document. Hong Kong: Food and Health Bureau. Retrieved from http://www.fhb.gov.hk/beStrong/files/consultation/exsummary_eng.pdf.
A total of 4900 written submissions were received. The consultation report was published in December 2008. It suggested that there was a broad consensus over the service reforms. However, there were divergent views on the supplementary financing options, no single option commanded majority support, though private PHI shows a relatively higher preference. It was also shown from the response that the public embraced five societal values, namely, individual need, voluntary participation, equity, freedom to choose and employer's responsibility. The FHB undertook to formulate a detailed proposal based on these public preferences to launch the second-stage public consultation.Food and Health Bureau. (2008). Your Health, Your Life: Report on First Stage Public Consultation on Healthcare Reform. Hong Kong: Food and Health Bureau. Retrieved from http://www.fhb.gov.hk/beStrong/eng/consultation/consultation_report1.html
Second Stage Consultation: 'My Health My Choice' (2010)