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Future Health Care Delivery Model.ppt by lovemacromastia


									Consultation Meeting on
   Hong Kong Future
   Healthcare Model

 Legislative Council Health Service Constituency
     Office of Dr. Hon. Joseph Lee Kok Long

           15th September 2005

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

Health Care Model
   Curative care
   Hospital services should be able to
    provide the best care for patients

Service Delivery Model
   Preventive care and continuity of care
   Home and family care play important

What should our future
service delivery model
   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

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

The future health care
model should embrace

1.   A health-conscious population
     adopting a healthy lifestyle,
     responsible for their own health
2.   A health care profession that views
     health promotion and preventive
     medicine as priorities, acts
     professionally and ethically
The future health care
model should embrace
3.   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
4.   A hospital service network which can
     provide emergency and secondary
     care within reach of the population in
     all districts
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

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

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

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

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
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
   Contribute towards professional health care
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?

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?
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?

Primary Health Care
   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
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
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

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

Professional implication

   How to initiate private sector to
    actively participate in the service
    provision? Who will pay for it?

Tertiary & Specialized

         The Trajectory

   Government-committed
   Concentrate expertise, resources &
    research on catastrophic diseases
    Provide affordable & sustainable
    specialized care to the unfortunate

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?

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
   Is the revamp itself sustainable at all ?

      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

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?

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?

    Ways to achieve

Concentration of expertise & services:
1. Consolidate services in a few
   designated centers rather than one
   mega center.
2. Work out planning guidelines based
   on caseloads & training demand
3. Review guidelines

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?

     Ways to achieve

Public-Private Collaboration :
1. Encourage private to develop tertiary
2. Engage private sector experienced
   doctors to practise on part-time basis
   in public hospitals.
3. Encourage collation of relevant data
   for better planning
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?

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?

     Ways to achieve

Strengthen the role of prevention :
1. Develop aggressive prevention
   strategy against chronic catastrophic
   illness & combination
2. Life style modifications, effective
   vaccination & disease management

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?
Elderly, Long-term &
Rehabilitation Care

       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

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 VMO ready to take the job? Will
    it help to strengthen the on-site
     Ways to achieve
    (elderly services)
Strengthen centers’ primary care :
1. Regular medical checks as licensing
2. Tightened collaboration between
   public, private hospitals, RCHEs,

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
   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?

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

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?
        The Trajectory
(Long term & rehabilitative
   Smooth the interface between
    hospital, rehabilitative and primary
    medical services

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

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?

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?                              49
Ways to achieve
(Long term & rehabilitative
The private & social Welfare
sectors needs to :
1. Develop short-stay institutions
   providing temporary convalescent &
   rehabilitative services
2. Refer deserving cases to CNS

3. Set up its own CNS for those
   economically capable                 50
Professional Implication

   How does the transfer of patients
    from tertiary public to private short-
    stayed rehabilatative made possible,
    having considered the different fee
    structures and service targets of the

Professional Implication

 What are the initiatives to encourage
  patients from public CNS to change
  to private CNS?
 Does it make sense for the private to
  set up its own CNS from economic
  perspectives? What are the social
  obligations for the private in opening
  up CNS?
     Ways to achieve
(Long term & rehabilitative
Universities & Training institutions
have to :
1.  Train health care workers & community
2.  Should we train the Health Care Assistants
    at universities or institutions ? Can we
    reflect on their present nursing standard
    and re-position their role of importance in
    our future care delivery model?

Professional Implications

   While there is no concrete plans and
    many uncertainties still loom, does it
    make sense to train a bulk of
    community nurses and special health
    care workers which may possibly lead
    to false estimation?
   Is there any overall HR planning on
    Health Professionals ?
Integration between the
private & public sectors

       Ways to achieve
   Foster the links & protocol between family
    doctors, 24-hr district based clinics & the
    public A&E on the triage criteria & waiting
   Establish referral protocols & shared-care
    programme for the care of stable chronic
   Division of work and specialization
    performed on the management of a specific


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