As part of its ongoing healthcare reform, the Hong Kong Government introduced
a voucher scheme, intended for encouraging older patients to use primary
healthcare services in the private sector, thereby, reducing burden on the
overwhelmed public sector. The voucher program is also considered one of the
strategies to further develop the public private partnership in healthcare,
a policy direction of high political priority as indicated in the Chief
Executive Policy Address in 2008-09. This study assessed whether the voucher
scheme, as implemented so far, has reached its intended goals, and how it
might be further improved in the context of public-private partnership.
This was a cross-sectional study using structured questionnaires by
face-to-face interviews with older people aged 70 or above in Hong Kong, the
target group of the demand-side voucher program.
71.2% of 1,026 older people were aware of the new voucher scheme but only
35.0% had ever used it. The majority of the older people used the vouchers
for acute curative services in the private sector (82.4%) and spent less on
preventive services. Despite the provision of vouchers valued US$30 per year
as an incentive to encourage the use of private primary care services, after
12-months of implementation, 66.2% of all respondents agreed with the
statement that "the voucher scheme does not change their health seeking
behaviours on seeing public or private healthcare professionals". The most
common reasons for no change in their behaviours included "I am used to
seeing doctors in the public system" and "The amount of the subsidy is too
low". Those who usually used a mix of public and private doctors and those
with better self-reported health condition compared to last year were more
likely to perceive a change in their own health seeking behaviours.
Our study showed that despite a reasonably high awareness of the voucher
scheme, its usage was low. The voucher alone was not enough to realize the
government's policy of greater use of the private primary care services.
Greater publicity and more variety of media promotion would increase
awareness but the effectiveness of vouchers in changing older people's
behaviour needs to be revisited. Designating vouchers for use of preventive
services with evidence-based practice could be considered. In addition to
the demand-side subsidies, improving transparency and comparability of
private services against the public sector might be necessary.