This video grab shows Commissioner for Primary Healthcare Stephen Pang speaking to Straight Talk's Eugene Chan, Feb 14, 2023. (PROVIDED TO CHINA DAILY)
Commissioner for Primary Healthcare Stephen Pang is on the show this week.
Dr Pang explains that relieving the burden on the public healthcare system rests on preventive measures. Hong Kong needs to make sure people seek advice from a family doctor, such as what kind of tests to do and what vaccines to get, by subsidizing private healthcare.
Check out the full transcript of TVB’s Straight Talk host Dr Eugene Chan’s interview with Dr Stephen Pang.
Chan: Good evening. This is Eugene Chan on Straight Talk. Our guest this evening is the Commissioner for Primary Healthcare. Dr Stephen Pang. Dr Pang is a specialist in geriatric medicine and the President of the Hong Kong College of Community Medicine. He is also a Clinical Associate Professor at the University of Hong Kong. He has over 15 years of executive experience in healthcare management and was a member of the elderly commission. Welcome, Stephen!
Pang: Hi, Eugene, thank you so much.
Chan: Pleasure. The Chief Executive announced in his maiden policy address that the government would publish a primary healthcare blueprint to revamp the current healthcare system. And you were appointed as our first commissioner for primary healthcare in November, followed by the release of the blueprint in December. So perhaps you can tell the viewers which I'm sure many are interested, what this is all about that and how it is different from the traditional treatment-based system that we had.
Pang: Oh, thank you. Primary HealthCare System is a system that most people should first reach and as a first contact before for they reach any health services, that's the best way, that's the people who get the health advice, and also start some preventive care. And then have the disease screening as well as the early detection of disease. In many countries, I understand they start the development of hospitals and specialists care, at the very beginning. But with people find that they have more evidence that more interventions can be started as early as possible to keep people healthy. And especially the lifestyle modification which need people's involvement and participation. So, health system in many Western countries, has already mature, and were developed in terms of system as well as the training in doctors as well as the other health and other nursing professionals. So that's why Hong Kong, we find that with aging population, this primary healthcare system is quite imminent that we need to catch up. And then to coordinate to make it more systematic,
Chan: Right, Dr Pang, I think I get your message saying that it is the first step that everybody should have screening prevention, I think this is what you're trying to tell me.
Pang: Right.
Chan: But why do we still have to promote primary health care when Hong Kong is quite well-known, at least in Asia, if not rest of the world, and we have a very well-established healthcare system with first-class hospitals, and very well-trained doctors from all over the world, I think we're quite renowned on being a member of the profession. Everywhere you go, I mean, Hong Kong academics are very well respected. Why do we still need that?
Pang: Yes, this is called health seeking behavior. In the past decade, the government spend a lot of investment in the secondary and tertiary care. So, we see that people would like to see specialists, and also go to hospitals whenever they are sick. But the problem is, when they go to see specialists, they will need to have… they usually have symptom sides, and you've had the complication of diseases. And the people use these types of the health seeking behavior, make them think that they only see doctors when they're sick. But the problem is that they should seek advice and take up more preventive care to make them healthy, especially when they get older and older. You know, the people need to enjoy the quality of life, instead of just have a prolonged life. You can imagine people when they don't understand whether they have any risk of disease, and they find that it's too late to go to the specialist. So that's why we need to build a system to allow people to access to the preventive care, and also have the right knowledge about intervention like vaccination, cancer screening, as well as the quarantine disease screening.
Chan: Right, Dr Pang, you mentioned the word aging, I'm sure all of us feel that the whole population, not just Hong Kong, the rest of the world is increasing into aging population, that means likely to have more chronic diseases. And I think everybody want to have better quality of life when they actually get older, not being suffering all the time. And that's a reason why you said prevention is the right way to go. Before we go any further, I think the first question, everybody…. Our viewers are very sophisticated, they're going to say… "Is this going to increase our overall public health care expenditure?" Because Hong Kong has spent a lot of money recently for very good reasons. We've heard that our bank balances the… it’s really dropping. Hopefully, our income will come again when everything goes back to normal. But why are we burdened… extra burdening our system, when we already have so-called very high healthcare bill that all of us have to pay. Is it worth it?
Pang: Yes, this is the point why we need to set up a new commission on primary health care. You know, Hong Kong has a lot of services at the primary health level, but the problem is they are all scattered. And you will find that… so you find it difficult to find information. And also, sometimes, don't know where you can access to this primary care. In the current system, the primary care in Hong Kong, like primary GP, and some of them take up the role of family doctors, but they find that in the current system, they just see the episodic illnesses, rather than can do a lot of continuous care. So, what we try to work on is that whether we have some consolidate need… to consolidate the resources that we have at the moment, like in the Department of Health, we need to look at whether we can improve some services through purchasing the services in the community. So there's the current practices that have private doctors, or some of them even performed a family doctor's role can be more, you know, systematic and in some sort of people can have easy access to them at affordable prices, and it’s better also have a habit that we need to tell people that the health should be share, like co-care programs with the government and as well as their healthcare professionals.
Chan: Dr Pang, I must ask you another question before you….
Pang: Yes, sure.
Chan: I'm sure you're very convicted to make this happen. But I want to say. As I said on Straight Talk. I ask you a straightforward question, because a lot of viewers said, let's be more direct. Our government has been trying to do many things in the past. And we really appreciate the intention. But we found that private sectors tend to be more cost-effective, more efficient in delivering this. Will this be an area of work that you would involve more of the private sector, because since you say you want to refer the patient to primary care,
Unfortunately, I have to say that many doctors in practice, they have the existing clientele. You telling me I'm helping you to promote my patient going see the other doctors? So how are you going to work with the private doctors?
Pang: Yes, that's why we need to work in the two ways. One is the set of the primary care model, what kind of model we need to set up. Secondly, is the how we can work with the current public health system at the moment, we have some programs already implemented, like public-private partnership programs at the specialist level and secondary care level. But the issue is the whether we can have more on the preventive care and at primary care level. So that's why we have a strategic purchasing office under both Hospital Authority as well as Primary Care Commission. So, we work together to see what sort of model we can have better purchasing through the private sectors. And also, we know that 70 percent of the primary care consultation actually happen in the private sectors. So, we try to see whether the private sector can take a more role as a continuous care. So, the system design is to try to facilitate and encourage the private sector to look after patients in the longer term and it built a longer relationship.
Chan: So, in other words, actually, you're transferring more patients to see the private sector rather than the public system?
Pang: I cannot see this is transfer because at the moment, the public hospital mainly takes up more than one to two million population as a disease… because they have disease and illness, but do you think about how about the other five million, whether they have a preventive care undergoing every day for them, like doing more exercise, lifestyle modification and have…
Chan: Basically, you're saying you're anticipating those who are haven't been needing treatment? Making sure they don't really need it at the end of the day.
Pang: Exactly, because we know as population gets aging, there are more and more chronic disease happen, because it's unavoidable. If you keep the current system, they will be much more people who see the public hospitals, when they got sick.
Chan: Right. So, with this primary care healthcare system, is it… primary health care, is it just the usual medical doctors we have to see, is there any other fields of healthcare professionals that will be promoted?
Pang: Yes, that's right. So, we try to build two streams in the system. First is family doctor for all and then they will have also built… tried to develop more district health network.
Chan: So, all western medicine?
Pang: Oh no. District health network means they will involve all the health professional health primary care and development and also want to work with them in a coordinated approach. So that's why like the district center, they can call this a… whether they will be network built with the other professional like dentist, Chinese medical practitioners as well as other health and nursing. So, this is we call multi-disciplinary approach. Just because family doctors or family medicine are quite well-established in some countries, so we try to explore whether the system can be start first.
Chan: So, you're saying that this healthcare promotion is not just looking as your … coming not from the western medical doctors, from Chinese medicine, even with dentistry. One thing I want to ask you about the blueprint, before you tell me more about it, I want to ask you, you've been trying to push this to make sure we understand the importance of prevention. But in Hong Kong, we have one of the highest life expectancies in the world. So how is this primary healthcare going to help me for example, by supporting it, how is it going to help my health?
Pang: Yes, we have a very long life. But as our Secretary for Health said, we really want them to live with quality health, quality life. So, in order to have a life with very good health, then we need to start the preventive care as early as possible. So many countries, they start the very strong the intervention for those age over 30 and 40. Because the average age, they have something they have to do like for women, about 25 years of age, they need to have cervical cancer screening. And for those over age 45, they start the diabetes screening. So those work they need to start as early as possible. Yes.
Commissioner for Primary Healthcare Stephen Pang attends the Straight Talk show on TVB, Feb 14, 2023. (PROVIDED TO CHINA DAILY)
Chan: When you said prevention, I just think of things like Chinese medicine or even in the dental professional.
Pang: Oh yes yes.
They’re both professions promote, sort of, treatment… actually work before actual treatment is needed.
Chan: More prevention.
Pang: Yes, dentist is very successful case, we can see when the average, kids and children's, they start to brush their teeth. Right?
Chan: Yes.
Pang: Then this is sort of prevention. So, dentists can also give preventive care to those people of any age.
Chan: Ok. Yes, right. Right. Dr Pang, let's go to a break now but viewers don't go away. We will be right back with more interesting points coming up.
Chan: Welcome back! We have been talking with Dr Stephen Pang about the government’s blueprint for primary healthcare, why it is important to implement this strategy in Hong Kong, and how it will provide healthcare services to our citizens.
So Dr Pang, in the first half you have stressed the importance of prevention, and you mentioned the goodwill by the dental profession or even the Chinese medical practitioners, that they have a different approach to sort of a more prevention aspect than treatment approach. And then you said 1-2 million population is being looked after by the public hospital system, and we are trying to look after the other 5 million. Hopefully they don't get ill, especially with the ageing population and chronic diseases. Have I got that right?
Pang: I think it is the coverage because healthcare system, if really just talk about treatment-base system, then you will be lack taking care about the other population who have no symptoms and signs. But basically, you know, everyone, if they start to take care of their health, and then to put attentions whenever they need to have some intervention, like screening and vaccination. So, after COVID, many people understand this concept already because they find that if they have the right vaccination, then they will be free from the disease or less symptoms. So there are many other vaccines which are very effective, and there is evidence that if the population starts to have those vaccinations with wide coverage, it can also achieve the health impact to the general public.
Chan: Right. Dr Pang, so another thing we have been talking about, general directions. Let's be more specific.
Pang: Yes.
Chan; So most people will go and see a doctor when they feel unwell, they don’t just go and visit them for screening. This is a general habit. They usually go to their own doctors. If my eye has problem, they go to their own ophthalmologist; their heart, they go to their cardiologist. What are you saying? Are you saying that from now on, we don't see them anymore, but just going to see the primary care doctors?
Pang: Yes. It is better to see… like even you have no symptoms, you can take the preventive advices from them. For examples, if you really wonder what sort of vaccination you should receive, not only about the subsidized vaccination program, we can be talking about something like for shingles vaccine… or about some other vaccinations which are also help in older people, like pneumococcal vaccination. So those vaccines can help, and you may need those information before you got any sick, right? And how about if you want to take an exercised prescription, whether what sort of exercise is you better to have. So you can see doctors to see whether these advices can be given, even though you have no symptoms.
Chan: Right. So, basically everything is prevention, prevention, prevention?
Pang: Yes.
Chan: Right. And you had a Chronic Disease Co-Care Scheme that you had, and it covers mainly… only hypertension and diabetes. What if some other diseases? When will they be covered?
Pang: We take diabetes and hypertension as the first step to try the co-care program because chronic disease management is not just the patient who had the diagnosis. Many diseases start at a very early stage, like diabetes, they have pre-diabetes, which can start the active lifestyle modification with some medication and control to prevent it from becoming the diabetes. So at the moment, the system has no access actually based in public sectors for the people to go get advice, and also start treatments. So what we try is to see whether people can have, you know, start the chronic disease management concepts. Hypertension and diabetes, if it is at a very early stage, it is mainly a sort of prevention, it is not a treatment in that sense. So we don't want to see the patient in the hospital with stroke, ischemic heart disease or renal failure because those who have very significant symptoms, but most people when they have started the hypertension, they don't have symptoms at all. Can we start the detection at early stage and start some treatment, even though they don't have much symptoms?
Chan: Right. Dr Pang, I must stop you here because the viewers are going to ask you: you are asking me to go to prevention rather than going to the hospitals.
Pang: Yes.
Chan: You are asking me not to see my doctors right away, but see the prevention first, which means very well. Does it mean that we have to shoulder our own medical expenses?
Because as I said to you before the show, I said I am sure some of us who bring our parents to the hospital would know that you pay a very basic fee, and then all the medicine you took away will be in quite a big bag, that you know is definitely way below the cost that you are paying. But when you go to a private doctor, they have to charge you a reasonable fee, and that amount would definitely be much bigger than the one you pay at the hospital. So is this the government trying to shift their burden to the citizens?
Pang: I think put it this way, because for the moment, when the person they go to the hospitals, they may not focus on the early disease. So you find that you need to wait for a very long queue, in a very long queue before you see a doctor. But you can imagine, if the disease can be treated and start intervention at early stages, instead of waiting in a queue without any intervention…
Chan: I agree.
Pang: So…
Chan: But who is paying for it?
Pang: Yes, that is another point. So we need to design a system to see whether we can sponsor or purchase the services from the private. And then we see at affordable prices, and even deciding what sort of support you can have, like laboratory support, as well as the medication support. So if the whole co-care program has achieved a few purposes, first is the family doctor concept, second is the affordable prices and consultation, as well as laboratory services, as well as medication, for chronic treatment or intervention, I can say. So if those things are well established through purchasing, then I think if a person can have a choice, say whether they can have a very good service of private with long relationship with the family doctors, and then they can get advices not only of the chronic disease, they can also get advices for other preventive care. So that if this system is well established, then compared with GOPD or a specialist center, they mainly provide medical intervention. And they won’t have doctors looking after you, to understand you, including your family, including your future, potential risks. They mainly see what disease you have, and they treat that. So I think in longer term, this system will take up more effect on the health of the whole general population.
Chan: Right. Thank you for reassuring the viewers that the government is consider on subsidies, in terms of laboratories, or even medication. I think that is one way to get the whole system started, I think I can see your intention. Can we say that, just in case, if someone has more serious illnesses, that the primary or family doctor will be able to refer them back to the specialists?
Pang: Yes, that is the one, also the way we need to explore with the current system because nowadays, we see the doctors refer the patient directly to the secondary care, and then tertiary care. But if the family doctors can have some sort of arrangement, see whether we can for some sort of special access, and then return the patient back to family doctors, in case the patient can be managed at primary healthcare. But of course, if the disease, you know, some diseases gradually deteriorate, up to the specialist level, then there could be some collaboration between family doctors and specialists.
Chan: Dr Pang, another thing I want to ask you about the enhanced Elderly Health Care Voucher. I mean how can the elderly get that extra HK$500 and how could they spend? Can they just spend on medical services or, as you said, Chinese medicine or dental services? Can they use that over that as well?
Pang: Yes, the Elderly Health Vouchers, the whole purpose is to encourage the people to seek preventive care.
Chan: All right.
Pang: But you understand that we also think that the patient choice is also important. But in order to encourage people to spend more time in preventive care, the new design of the additional $500 is when a person spends $1,000 on the preventive care, no matter it is western medicine, Chinese medicine, or dental services. So if they have that sort of services already spent on that, they can have additional $500.
Chan: One question: people also ask, “I have been going to the hospital, and how about my personal healthcare record? Can they be transferred to the family doctors?”
Pang: Yes, that is a very key question because now, we spend a lot on studying and try to enhance the e-health system, now we promulgate in both public and private. We understand that ‘one person, one record’ is critically important for the communication, especially between the primary care and the secondary care.
Chan: Right.
Pang: So this is the one target we need to achieve.
Chan: Also I saw that on your list, there are over 6,000 family doctors in Hong Kong, and just around 2,700 are registered, so do we have enough doctors? Just in case everybody goes to this system and support your initiative.
Pang: I think it really needs time to achieve two things. Firstly, the general public accepts the family doctors to take care of their general health; secondly, our doctors they will take up more role in preventive care, as a long-term relationship built with the patient. So we will develop systems that allows for registration, like other countries they try to develop. And so this is the one thing. Another we try to provide incentives to the private…
Chan: Dr Pang, I am going to ask you the last question before the show ends. You know CE said that it is going to take 10 years to change our culture from treatment base to more prevention, which you have explained why we need that. What type of KPI, key performance index, will you put to this system to say that you are successful? Because 10 years is a long time. I mean a lot of people would say “I am already 80 years old,” so how would you answer my direct question? What is your KPI that you are successful? Sorry to be so direct.
Pang: Maybe for KPI, we need really need some time studying, but I really expect to… one thing happen is that once the time the patient goes to the emergency department and the professionals say who is your family doctor, and that would be really the true success of the primary healthcare system.
Chan: Dr Pang, thank you for a very direct answer. We want to thank Stephen for sharing the government’s blueprint for reforming our healthcare system. This seems to be a step in the right direction with our ageing population and increased in chronic disease. We will all need to embrace this change to reap the benefits of our future. Have a good week and goodnight!