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WE NEED TO CHANGE TO BE FIT FOR

PURPOSE

Conventional health systems which focus on acute hospital-centric care are ill-
equipped for the new socioeconomic norms associated with an ageing population.
Longer living populations and rising prevalence of preventable conditions which
are lifestyle-related and socially determined raise questions about how the health

system can operate effectively, efficiently and sustainably in the emerging health
landscape. Advances in technology will simultaneously present new opportunities
while disrupting current healthcare provision and financing models. Any meaningful

attempt to address the fundamental mismatch between services and a shifting

demand profile necessitates a whole-of-society and life course approach. This
will involve complex interventions and continuous life course care, requiring us to
change how health systems are oriented and organised.

WHAT DO WE MEAN BY A “FIT FOR PURPOSE HEALTH SYSTEM”?
• A system suited to accomplish its intended purpose.
• Changing in a changing world:
- Changing context: an ageing population, and rising prevalence of

preventable chronic illness and loss of capacity in˜uenced by the
social determinants of health.
- Changing needs: physical, mental, social and spiritual health
needs across the life course.
- Changing knowledge and technologies: new medical knowledge,
medical technology and information and communications technology
disrupting conventional models of care.
• Changing system: transformations for primary care-led integrated
person-centred care.

Hong Kong’s health system is failing to adapt and unless the pace of transformation
is quickened it will face insurmountable challenges. Our health system is fragmented
with patients falling through the cracks found between our primary and hospital
services, long-term and community care, and between our public and private
sectors. International best practices such as community care and primary care
are relatively underdeveloped locally, despite being key areas to manage future
demand. The symptoms of the current malaise are already visible. Extended wait-
times and diminished access to services are now commonplace. Nearly half of
hospital admissions in the public sector are ambulatory care sensitive conditions
which could be dealt with in community settings (The Jockey Club School of Public
Health and Primary Care [JCSPHPC], 2017). The unplanned readmission rate within
30 days is 20%. Together, this indicates problems with care quality, inadequate
support for discharge care in the community, and lack of integration between health
services at different levels of care and between health and social care (JCSPHPC,
2017).

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