Hong Kong 2006

Primary health care is the first point of contact where individuals and their families are subject to a continuing healthcare process, which aims at avoiding hospitalisation and improving their health condition in general.

Public general outpatient services are primarily targeted at low-income families, patients with chronic diseases and other vulnerable groups. Throughout the territory, the Hospital Authority operates 75 general outpatient clinics. In 2006, about 4.9 million visits by 1.3 million patients were recorded at those clinics. Since October 2006, appointments for consultation can be made by telephone. Some $1.3 billion were spent on public general outpatient services in the financial year 2005-06. There were continuing efforts at these clinics to promote the development of family medicine and enhance the interface and integration of primary and secondary care, as well as enhance the quality and efficiency of primary healthcare services.

To promote the development of 'evidence-based' Chinese medicine practice and to enhance training opportunities for local Chinese medicine graduates, the Hospital Authority has opened five new Chinese medicine outpatient clinics in 2006, increasing the total number of Chinese medicine outpatient clinics from three to eight.

In 2006, a subvention of $32.4 million was provided for the clinics. A total of 25 793 patients made an aggregate of 132 062 visits to the eight clinics and 37 graduates were newly recruited.

The majority in the community seek outpatient services from the private sector, provided by around 6 000 medical practitioners in private practice and 165 clinics registered under the Medical Clinics Ordinance. Services from 5 268 registered, 68 limited registered and 2 897 listed Chinese medicine practitioners in private practice are also available.

It has been estimated that there are about 27 million and 6 million outpatient attendances at western private practitioners' clinics and Chinese medicine private practitioners' clinics respectively each year. These services are generally affordable to the majority of the population.

Apart from general outpatient services, the public sector provides specialised services targeted at citizens of particular age groups or medical conditions.

For children up to five years of age, and women aged 64 or below, the Department of Health provides a comprehensive range of health promotion and disease prevention services through its 31 maternal and child health centres and three woman health centres. At the centres, anticipatory guidance on child care and parenting is provided for parents and care-givers. Immunisation, health and developmental surveillance services are offered to children. Antenatal, postnatal, family planning, cervical screening services and health education are provided for women. Some 24 000 expectant mothers and 57 000 newborns attended maternal and child health centres, representing about 36 per cent and 87 per cent respectively of the total in 2006. The majority of the remaining expectant mothers and newborns seek antenatal services from the private sector.

Concerning sexual and reproductive health services, the government-subvented Family Planning Association (FPA) of Hong Kong offers a range of fertility treatments, check-ups, counselling, and pre-marital and pre-pregnancy preparation through its various clinics, youth healthcare centres, women's clubs, and libraries. In 2006, the subvention amounted to $29.6 million and over 120 000 clients were served. With the objective of strengthening family life and promoting sexuality education, FPA opened the new Tsuen Wan centre and co-organised the First Hong Kong Sex Cultural Festival with various local organisations in 2006.

For primary and secondary school students, the Department of Health offers health assessment, health education and individual health counselling with an emphasis on health promotion and disease prevention through its 12 student health service centres and three special assessment centres. In 2006, services were provided to 756 054 students between the ages of six and 19.

Furthermore, to safeguard students' health, school health inspectors, health officers and nurses pay regular visits to schools to disseminate information on environmental hygiene and sanitation, to advise on the control of communicable diseases and to organise immunisation campaigns.

For people aged 65 or above, a comprehensive primary healthcare service is offered by the Department of Health through 18 elderly health centres and 18 visiting health teams. The services include health assessment, physical check-up, counselling, curative treatment, and health education. Such services are aimed at enhancing primary healthcare for the elderly, improving their ability to care for themselves, encouraging healthy living and strengthening family support to minimise illness and disability of their elders. The 18 visiting health teams reach out to the community and residential care settings to conduct health promotion activities for the elderly and to provide training to carers to enhance their health knowledge and skill in caring for the elderly. In 2006, the elderly health centres recorded 38 042 enrolments and 186 167 attendances for health assessment and medical consultation, while the visiting health teams made 276 941 client contacts.

In view of the international trend of focusing on the development of ambulatory and community care programmes, the allocation of public funding for public hospital services has been changing from the institution-based approach to a population-based approach to encourage the mobilisation of resources from institutions to community settings.

In 2006, the Hospital Authority continued to step up training for family physicians, community paediatricians, community physicians, general practitioners and community allied health practitioners to support the development of the community mode of healthcare delivery. To provide outreach medical, nursing and allied health services to support discharged patients for rehabilitation in the community, the Hospital Authority has also strengthened its community-based outreach teams: community nursing services, community geriatric assessment teams, community psychiatric teams and nursing services, and community allied health services. Through on-site training, home carers are also empowered to deliver community health services on a collaborative basis. In the financial year 2005-06, the Authority spent $600 million on community health services. In 2006, 801 500 community nurse home visits as well as 809 600 outreach attendances for elderly and psychiatric patients were recorded.

Over 80 per cent of the clients of community nurses are elders. In recent years, medical support for elders discharged from public hospitals has been enhanced through the implementation of a number of new initiatives. For example, visiting medical officers were deployed under the supervision of community geriatric assessment teams to provide weekly on-site medical visits covering over 200 homes for the aged in 2006. Volunteer networks were established to provide immediate essential assistance to discharged elderly patients. The telephone nursing consultation service was introduced to provide home instructions and advice on disease management. More community nurses were deployed to station at care centres and non-governmental organisations to provide on-site care at the care homes of patients.

With regard to rehabilitation and palliative services, the Hospital Authority has re-modelled the Tang Shiu Kin Hospital into an ambulatory care centre in early 2006 to take on discharged patients for short-term rehabilitation and to start an integrated palliative day care centre to provide a full spectrum of physical, rehabilitative, psychological and spiritual services to the patients and families in need.

Preventive dental services including annual dental examination and basic dental care are provided by the Department of Health to about 398 000 children per year, aged six to 12 years, covering about 92.7 per cent of the primary school children of Hong Kong. For the general public, there are 11 designated dental clinics that provide emergency dental service for pain relief and extraction. The department also offers specialist oral healthcare services to hospital in-patients and those with special oral health needs. The majority of general dental services are provided by the private sector. The department also monitors the level of fluoridation in the communal water supply in order to reduce dental decay among the population.

See Chapter 10 for contents relating to public mental health services.

The Department of Health operates a number of specialised clinics for the public: 20 methadone clinics, 19 tuberculosis and chest clinics, seven social hygiene clinics, four dermatology clinics, two integrated treatment centres, four clinical genetic clinics, seven child assessment centres, two travel health centres and other clinic services. About 7.5 million visits to these clinics were recorded in 2006.