Primary healthcare will be the best way forward


Primary healthcare will be the best way forward

By Zorina Kwong and Kacee Ting Wong

An issue of great concern is whether Hong Kong’s medical and financial resources could be stretched to the maximum extent to maintain an over-burdened treatment-oriented and hospital-based healthcare system in the long run. Disappointingly, the answer is no. In order to make our healthcare system sustainable, we must ease the excessive burden on the hospital-based public healthcare system. It is an unassailable fact that a primary healthcare system offers a way out of the impasse.

In his 2022 Policy Address, Chief Executive John Lee Ka-chiu took an important step in the right direction by providing a medical roadmap showing how the promotion of primary healthcare could make Hong Kong’s healthcare system more sustainable. Primary healthcare is the first point of contact for individuals and families in a continuous healthcare process in the community, which entails the provision of accessible, comprehensive, continuing, coordinated and person-centered care. It serves as a gateway to specialized secondary and tertiary healthcare in hospital and institution settings (Primary Healthcare Blueprint, Health Bureau, December 2022).

Back in 1990, the Working Party on Primary Healthcare published a report with 102 recommendations. One of the recommendations was the establishment of a statutory primary healthcare authority to oversee the provision of primary healthcare in Hong Kong (Medical and Health, by Leung Man-fu, in The Other Hong Kong Report, Choi Po-king and Ho Lok-sang (eds.) (HK: Chinese University Press, 1993)). But this recommendation has been left on the shelf for many years. The long waiting game will soon come to an end with the establishment of the Primary Healthcare Commission next year (Establishment of the Primary Healthcare Commission, by F.C. Pang and S.S. Lai, in Hong Kong Medical Journal).

Although most of the recommendations of the working party have been relegated to the backburner, the Hong Kong Special Administrative Region government has not turned a blind eye to primary healthcare. In March 2008, what was then termed the Food and Health Bureau published a consultation paper on primary healthcare. In response to the consultation paper, Sian Griffiths and Jeff Lee have drawn attention to the established mainstream view in the medical world that a modern healthcare system needs to be based on primary healthcare (Sian Griffiths and Jeff P.M. Lee, Developing Primary Healthcare in Hong Kong: Evidence into Practice and the Development of Reference Frameworks, in Hong Kong Medical Journal).

It’s worth noting that Our Hong Kong Foundation also supports the need to build a primary healthcare system. In its 2018 report, the foundation noted that over half of people in hospitals suffered from problems that could be dealt with in community clinics (Fit for Purpose: A Healthy System for the 21st Century, in Our Hong Kong Foundation). Therefore, public health functions of health protection, health promotion, disease prevention, surveillance and response, and emergency preparedness need to be integrated with primary and specialist care (ibid).

Financially speaking, public spending on healthcare will increase rapidly in the future not because of rising population numbers but because of aging. One study estimates that it was 8.5 times more expensive to treat those aged 75 or over than to treat those aged 15-64 (Fixing Inequality in Hong Kong, by Richard Wong (HKU Press, 2017)). From a manpower perspective, public expenditure on healthcare should not be cut because it is an indirect investment in human capital and labor productivity.

The over-reliance on a hospital-based healthcare system has resulted in inadequate public expenditure on primary healthcare services. As evidenced by Hong Kong’s Domestic Health Accounts in 2019-20, only around 17 percent of the total public current health expenditure was spent on primary healthcare, with the remaining 83 percent spent on secondary and tertiary healthcare services (F. C. Pang and S. S. Lai, ibid). As Pamela Tin correctly pointed out, during the fifth wave of the COVID-19 pandemic, the hospital-centric system struggled to meet the demands of non-COVID-19-related care despite service availability in the private sector (Better Primary Healthcare Needed During and Beyond the Pandemic, by Pamela Tin, in Our Hong Kong Foundation).

Tin also argues that a stronger primary healthcare ecosystem could have pushed for quicker vaccination uptake and education during the pandemic. Because of the weak primary healthcare system in the city, many old people remained unvaccinated. If the vaccination rate had increased, the COVID-19 death rate would have been reduced. As a result, we should strengthen the primary healthcare system in order to enhance our disease prevention capability.

Recently, the death of two intellectually disabled brothers in Sau Mau Ping Estate has further prompted calls for better community services. Another tragedy occurred in a private flat in Happy Valley in June 2023. Firefighters found an extremely weak and dehydrated 75-year-old woman in her flat. Her younger brother and carer, 71, was found dead in the bedroom. Perhaps District Health Centers should play a greater role in monitoring these hidden patients.

When Secretary for Health Professor Lo Chung-mau introduced the Primary Healthcare Blueprint in late 2022, he focused on prevention and early detection and diagnosis. The major directions of primary healthcare reform include developing a community-based primary healthcare system to further develop the district-based, family-centric community healthcare system based on the service model of district health centers as well as strengthening the concept of “family doctor for all”.

Some of the recommendations of the Primary Healthcare Blueprint include establishing a two-way referral mechanism between primary healthcare services and specialist and hospital services; adopting the co-payment principle in providing government-subsidized primary healthcare programs; reinforcing primary healthcare manpower; and improving data connectivity and health surveillance. There is not the slightest shadow of doubt that the government has strong determination to put the above recommendations into practice. As an indication of its determination, the Chronic Disease Co-Care Pilot Scheme will be introduced in November 2023 to take preventive measures to combat chronic disease.

Zorina Kwong, formerly a registered nurse, is the community pro-bono services senior adviser of Chinese Dream Think Tank.

Kacee Ting Wong is a barrister, part-time researcher of Shenzhen University Hong Kong and Macao Basic Law Research Center, and chairman of Chinese Dream Think Tank.

The views do not necessarily reflect those of China Daily.

【CDTT Newspaper Article】Zorina Kwong and Kacee Ting Wong:Primary healthcare will be the best way forward (China Daily HK Edition, 27 Nov 2023)

Chinese Dream Think Tank is a non-profit Hong Kong-based organization working with skilled volunteers, experts and professionals who are passionate about telling the China story well.

This article is reproduced by Kwun Media with the consent of China Daily.

中國夢智庫| 特區的「基層健康服務」系統 




雖然只有少數「基層醫療工作組」的建議得到引用,但特區政府一向都對基層醫療保持非常重視的態度。2008年3月,「食物及衛生局」發表《掌握健康,掌握人生——醫療改革諮詢文件》(註6)。葛菲雪教授(Sian Griffiths)與Jeff Lee積極回應了這份改革諮詢文件,兩位學者正確指出,現代醫療保健系統需要以基層健康服務為基礎,這是醫學界的主流觀點(註7)。




 田詩蓓博士認為,在疫情大流行爆發期間,更完備的基層醫療服務生態系統可更快的推動疫苗接種效率與相關教育(註13)。由於特區的基層醫療服務系統尚未完善,當時許多老年人仍未接種疫苗。可以說,如果疫苗接種率提高,COVID-19 死亡率就會降低。因此,特區應加強基層醫療服務體系,以提高特區全體居民的疾病預防能力。

近日,兩宗新聞令人心痛。早前,秀茂坪邨兩名智障兄弟不幸去世。2023年6月,消防員在位於跑馬地一間私人公寓發現一名極度虛弱與嚴重脫水的75歲婆婆,她 71 歲的弟弟與外傭被發現死在臥室內(註14)。因此,「社區衛生中心」應能在監測社區隱藏病人方面發揮更大作用。上述例子顯示,進一步推動改善基層醫療服務系統有燃眉之急。

 醫務衞生局局長盧寵茂教授在2022年底公布《基層醫療健康藍圖》(「藍圖」)時表示:「… 加強香港基層醫療服務,以預防為重、社區為本、家庭為中心、早發現早治療為策略,並以改善市民整體健康狀況、提供連貫全面的醫療服務、建立可持續的醫療系統為願景…」。「藍圖」的重點改革方向是建立社區基層醫療系統,強化一人一家庭醫生概念,務求令市民不用動輒到醫院求醫或接受健康管理;當局同時加強管理,完善基層醫療服務與專科、醫院之間的雙向轉介流程,以及整合基層醫療健康資源,優化長者醫療券計劃與其他資助服務(註15)。



註 1: 醫務衛生局「基層醫療健康藍圖 附篇」2022年12月,第10頁 available at:

註 2: 同上,第6頁

註 3: Leung Man-fu「Medical and Health」in Choi Po-king and Ho Lok-sang (eds.) The Other Hong Kong Report, Chinese University Press 1993 at p 224

註 4: 新聞公告「基層醫療健康專員履新」07.11.2022, 第三段 available at:

註 5: F.C. Pang and S.S. Lai「Establishment of the Primary Healthcare Commission」Hong Kong Medical Journal Vol.29, No.1, February 2023 at p 6

註 6: 食物及衛生局「“掌握健康掌握人生” 醫療改革公眾諮詢 第一階段公眾諮詢報告」Feb 2009 立法會CB(2)819/08-09號文件 available at:

註 7: Sian Griffiths and Jeff P.M. Lee「Developing Primary Healthcare in Hong Kong: Evidence into Practice and the Development of Reference Frameworks」Hong Kong Medical Journal Vol.18, No.5, October 2012 at p 429

註 8: 團結香港基金「以人為本 縱橫整合 香港醫療體系研究報告」03.12.2018 available at:團結香港基金/以人為本-縱橫整合

註 9: Our Hong Kong Foundation「Fit for Purpose: A Healthy System for the 21st Century」30.11.2018 at p 3

註 10: Richard Wong「Fixing Inequality in Hong Kong」 HKU Press 2017 at p 233

註 11: 同前,註 5

註 12: Pamela Tin「Better Primary Healthcare needed during and beyond the pandemic」Our Hong Kong Foundation at para 4 (English only) 12.09.2022 available at:醫療及老齡化/better-primary-healthcare-needed-during-and-beyond-pandemic

註 13: 同上

註 14: Fiona Chow and Clifford Lo「Hong Kong welfare chief pledges more support for carers, after 2 intellectually disabled brothers believed to have starved to death in mother’s absence」SCMP 22.09.2023 available at:

註 15: 政府新聞網「基層醫療健康藍圖公布」19.12.2023 available at:

註 16: 同上