Healthcare Policy Systems: Hong Kong, Australia VOUCHERS FOR THE ELDERLY

Healthcare Policy Systems in Hong Kong and Australia

Primary Health Care for the Elderly in Hong Kong

Primary care is the starting point in the healthcare process (PCO, 2011). A good one is made available to the public for a comprehensive, holistic, coordinated and in locations accessible to where people live or work. It also provides preventive care and optimal disease management. In Hong Kong, approximately 70% of clinical consultations are made with primary care practitioners belonging to the private sector. The public sector, on the other hand, acquires primary care from hospitals through outpatient services and the Department of Health for preventive public health services, health promotion and disease prevention and management programs and services (PCO; Woo, 2007).

Primary care has been emphasized as a priority in international for a and reports, such as the 1978 International Conference on Primary Care, the World Health Report in 2008, and the 61st session of the Regional Committee of the World Health Organization Regional Office for the Western Pacific in October 2010 (PCO, 2011; Woo, 2007). In response to these initiatives, the Hong Kong government came out with a report on the Working Party on Primary Health Care, entitled "Health for All -- the Way Ahead" in 1990. This report reviewed the primary care system in the region and came up with suggestions on how primary care being extended then could be enhanced and reformed in pursuit of the objectives of international objectives. The Hong Kong government took certain steps to improve the public system of primary care since 1990. These measures included women's health service in 1994, student health service in 1995, elderly health service in 1998 and maternal and child health from 2000-2007. In caring for the elderly, hospitals have been cooperating and coordinating with non-government organizations in providing improved care to the elderly and chronically ill citizens. Among its primary care initiatives under the 2010-2011 policy agenda were the elderly health care voucher pilot scheme and the elderly vaccination subsidy scheme (PCO, Woo).

Voucher Scheme Insufficient

Increasing inflation and wealth gap in the region require that the elderly be provided more than just the voucher scheme to help them cope with current conditions (Jiaxue, 2014). This was the urgent recommendation of social welfare groups in expectation of more healthcare funds and home services. These groups called for a truly sustainable universal retirement program to respond to the real situation of the elderly population. Finance Secretary John Tsang was quoted as saying that the voucher pilot scheme would be extended by three years and double the value of the vouchers to HK$500 for every holder. The government furthermore sought clearer explanation of consultation fees to ward off medical inflation and to encourage voluntary organizations to establish ore services for older citizens. Improved public hospital services and provision for community healthcare services, affordable food at community levels by the food banks are other measures sought to augment the benefits of the Elderly Health Care Voucher Scheme. Other suggestions included a red back of HK$500 every Human Day, adjustment of the comprehensive social security assistance, more residential care homes and long-term care in communities, and reduced waiting time for home placements. But social work groups insisted that a universal retirement protection is still the best solution to the worsening condition of elderly citizens in Hong Kong (Jiaxue).

Healthcare Voucher Scheme for the Elderly in Hong Kong

This Scheme went on trial basis from 2009 to 2011 to provide partial subsidy for the older population already receiving private primary care (GAA, 2008). Under this Scheme, those aged 70 and over and possess a valid Hong Kong identity card or certificate exemption are entitled to give health care vouchers worth $50 each every year in partial subsidy for their primary private medical care services. A steering committee was assigned to implement it. This committee consists of the Food and Health Bureau, the Department of Health, the Hospital Authority and the Office of the Government Chief Information Officer (GAA).

The vouchers will be issued and used electronically and eligible seniors need not pre-register or collect the vouchers (GAA, 2000; HB, 2008). This will prevent the loss of vouchers and the need to bring them when needed. They are usable for three consecutive years but cannot be issued in advance. Seniors can use these vouchers in paying their chosen Western or Chinese...

Seniors only need to present their valid Identity cards or certificate of exemption in using the vouchers (GAA, HB).
Eligible seniors can choose from among 62 non-profit but officially recognized providers, 34 of whom provide both day care and home-care services (GAA, 2000; HB, 2008). They select their service providers within the three months from the date of issue of the voucher. A service catalogue will then be given to them for reference by the service providers along with price lists (GAA, HB).

Evaluating the Usefulness of the Voucher Scheme in Hong Kong

The purpose of this Scheme is to encourage senior citizens to use primary healthcare services in the private sector to decongest the load of the public sector (Yam et al., 2011). It is also a strategy aimed at developing the public-private healthcare partnership, which is a high-priority political policy. A cross-sectional study was conducted among the seniors using this Scheme in order to measure its success in attaining intended goals as well as come up with recommendations for improvement. Questionnaires and face-to-face interviews were the methods used in the evaluation (Yam et al.).

Results showed that 71.2% of the 1,026 surveyed seniors were aware about the Scheme but only 35% of them ever made use of it (Yam et al., 2011). Most of those who used the vouchers have done so for acute curative services in the private sector at 82.4% who spent less for preventive measures. After the first year of implementation, 66.2% of all those surveyed felt that it did not change or influence their health-seeking attitudes about consulting with either public or private healthcare professionals. It did not increase their motivation to seek professional assistance or advice about health. The most common reasons for this lack of change in attitude were their being accustomed to seeing doctors in the public system and the low subsidy. Those surveyed who consulted with both public and private doctors and those who reported their health conditions were more inclined to have a change in their health-seeking attitude or behavior (Yam et al.).

The evaluation concluded that the reasonably high level of awareness about the Scheme did not encourage a correspondingly high level of usage (Yam et al., 2011). The use of the voucher scheme alone was shown to be inadequate in inducing the greater use of private primary services. The reason for the disinclination should be explored and addressed. Using vouchers for preventive services with evidence-based practice may be a way of addressing the issue. As regards subsidies, improving transparency and comparing the services provided by the private sector with those of the public sector may need to be done (Yam et al.).

Australia's Elderly Health Care System

A Brief Profile

Six self-governing States and two self-governing mainland territories comprise the federation of the Commonwealth of Australia, which was established in 1901 (UNO, 1997). The Australian Constitute defines the federal government's powers and responsibilities. All other matters are under the jurisdiction of state and territory governments. Australia has approximately 750 local councils (UNO). As of 2013, Australia had an estimated population of 22,262,501. Of this number 114.7% are 65 years old and older while the largest group consists of the 25-54-year-olds. Australia devotes 9% of its GDP to health expenditures (CIA, 2014). It is considered one of the best places to live in the world in terms of income, human development, healthcare and civil rights (BBC, 2013).

Evolution

It enjoys universal coverage through Medicare (The Commonwealth Fund, 2014; Healy et al., 2011). Taxes fund this public insurance program for most medical care, such as physician and hospital services and prescription drugs. The federal government funds and regulates most of the health services, while the states and territories handle public hospital care. Aside from Medicare, about half of all Australians enjoy government-subsidized private insurance coverage of services like dental care and private hospitals. Most physicians are in private practice and paid on a per-service basis while general practitioners function as gatekeepers to specialized care. Most hospital beds are in public hospitals although private patients receive treatment in public hospitals. Public hospital physicians not only earn salaries and additional fees from private patients. They may also be in private practice and get paid by the hour for treating public patients. Present policy aims at shaping a new management structure for public hospitals in local area networks, raising the federal government's contribution to public hospitals, enforcing performance reporting and fortifying primary care (The Commonwealth Fund, Healy et al.).

Politically Determined

Australia's political decision-makers determine all the policies and priorities of its healthcare system as well as the resources to go into it (Stieber, 2005). The…