Healthcare and the challenges it brings are common across the Western world. Too often, we forget that Asia has many countries which are both first world and decidedly Western in their approach to healthcare. Hong Kong is one of those places.
The Hong Kong Hospital Authority funds an extensive network of primary healthcare facilities to support the disadvantaged within its seven million people. For those folks who qualify for state funded care, the quality and comprehensiveness of delivery is something which would have every Medicaid and Medicare patient in America green with envy. The localised access to comprehensive care in one building would also be favourably received by many Australians who often transit between a number of providers for their chronic disease care.
Hong Kong adopted the notion of polyclinics many years ago. Their entire publicly funded primary care network follows this model. This means that within one local facility, patients can access general practitioners, nurses, optometry, psychology, dietetics, podiatry, pharmacy and a range of nurse led clinics and education programs. In line with disease prevalence, the focus of these clinics is on care related to hypertension, diabetes and respiratory illness. Supporting overall health objectives, every clinic runs smoking cessation programs and provides immunisation and screening for a variety of diseases. Most of these activities are delivered by highly skilled nurses and allied health practitioners working with well developed protocols and systems.
Whilst the volume and pace of activity through these clinics might leave most other health systems exhausted, Hong Kong’s clinicians are a cheerful and progressive bunch. Significantly, Hong Kong’s population mirrors New Zealand in terms of having comparatively recently seen public provision open up in primary care. Consequently, patients are polite and grateful for the services they receive and willing to acknowledge the value of the care delivered. The access to free drugs dispensed on site might make some of Australia’s pensioners argue harder for like provision in Australia.
Of course, such modern and well designed facilities come at a cost. Not every Hong Kong national is entitled to free care in these clinics. Access and payment is based on income criteria. In addition, the workload of the clinics is such that patients with acute care needs are sometimes treated in hospital Emergency Departments to ensure that the core chronic disease work of the polyclinics can continue uninterrupted. The clinics are given set funding and quotas of activity. Once these are reached, overflows of patients, often those with acute needs are directed to care in other settings. In addition, patients are guaranteed care but not the same clinicians delivering the care. This is similar to the coordination of care provided in Canada and the UK’s walk-in clinics. Both of these countries are moving towards creation of Medical Homes where patients can access the variety of care often seen in Hong Kong’s clinics but with the same team of clinicians. Therefore, it would appear that Hong Kong has led many parts of the West with the creation of first rate infrastructure in its polyclinics. Adding to this comprehensiveness, closer relationships with patients may be the next step forward. Given shortages of doctors and nurses, this may only be possible if Hong Kong follows the trend observed on this trip, broadening the role of nurses so they are working at the top of their scope of practice. This could free up doctor time so that they have more flexibility to see the same cohort of patients. It could also result in more of the acute care occurring in primary care settings through an appropriate mix of nursing and medical availability. Fortunately, Hong Kong is investing in its nurses. For a number of years they have been running a scholarship program which funds 100 nurses a year to visit other countries for up to a month to broaden their skills and exposure to other practices.
The energy, optimism and achievement orientation of Hong Kong has seen it emerge from an inhospitable jungle to one of the world’s greatest trading centres in less than 50 years. 50 years from now, we can confidently postulate that Hong Kong will still be providing high quality care because as a nation they sense opportunities and find the best solutions across the world to answer the need. Perhaps more people from the West should visit their shores just as they so actively come to ours to seek out new knowledge?
Tracey Johnson, General Manager, Inala Primary Care