Harnessing NGO Capabilities in
Providing Chinese Medicine Services
Professor William Ho
School of Public Health and Primary Care
The Chinese University of Hong Kong
HMP-Framework: Instruments
Grow
A well-functioning part of
the private sector
Harness
Convert
A large number of provider
NGOs
Government shifting from
funding to purchasing
•
 NGOs historically
providing Chinese
Medicine services in
Hong Kong
 Could contribute more
by expansion
 could be leveraged to
serve public patients
From “NHS” to social
health insurance system
 could leverage private
resources to expand /
improve services
currently provide by
goverment
 could be improved by
active management of
service quality
•
Public-PrivatePartnerships in
investment, delivery, or
management
Policy and Programmatic Instruments
•
•
•
•
Regulation
Contracting
Training/Information
Social marketing
• Social franchising
• Info. to patients
• Demand-side
(incl. Vouchers)
Source: Adapted from Harding & Preker, Private Participation in Health Services, 2003.
• EQA / Accreditation
• PPP transactions
• Enable environment
improvement
Outline for Presentation
• Introduction of a new public service funded by
the government
• Strategic considerations:
• Strengths and weaknesses of public system
• Strengths and weaknesses of private system
• Potential benefits of synergy between the two
• Key take-home messages
Questions to Participants
• To what extent do people in your country use
alternative medicine/Chinese medicine?
• Are there government regulations on
alternative medicine/Chinese medicine?
• Is there government funding on alternative
medicine/Chinese medicine services?
• Is there public provision of such service, and if
so, any opportunity for PPP?
Use of Chinese Medicine in Hong Kong
>=15 yrs, Hong Kong Thematic Household Survey, 2005 (N=36,724)
Visited a healthcare
professional in the
past 12 months:
(n=18,087)
Visited western
practitioner only:
80.23%
Visited both
western & CM
practitioners:
16.60%
Visited CM
practitioners only:
3.17%
Situation Before Change
• Public hospitals and clinics under the Hospital
Authority provide heavily subsidized western
medicine service only
• NGOs and private solo practitioners provide
CM out patient services to community, mostly
through out of pocket payment
• Government provides token financial support
to some NGO for the poor
• Affordable but low/variable quality
Return of Sovereignty 1997
CM Policy under New Government
• 1997 – Chief Executive of HKSAR announced
commitment to CM development
• 1998 – First Bachelor of Chinese Medicine
course in local university
• 1999 – Chinese Medicine Ordinance passed
• 1999 – The statutory Chinese Medicine
Council of Hong Kong established
• 2000 – Registration of CM practitioners began
Policy Goals
• Public provision of subsidized, regulated CM
service in all 18 geographic districts to meet
community demand
• Develop CM as important component of
Primary Care, especially for chronic diseases
• Set the benchmark of modernized CM service
management through the public clinics
Issues of Concern
• Public sector does not have experience in
running CM service
• Skepticism/opposition from western-trained
doctors and nurses in public hospitals and
clinics to Chinese medicine
• How do you pay CM practitioners?
• High caliber CM practitioners few in Hong
Kong as compared to Mainland China
Questions to Participants
• What are the strategic questions regarding
contracting out the service to private sector?
• How to assess capabilities and potentials of
the private sector?
Strengths of Public Sector
• Well established Hospital Authority system
• Management know how in:
Service planning and facilities building
Human resources management and professional
training
Clinical quality management including risk
management
Pharmacy system, IT infrastructure
Economy of scale and financial know how
• Potential for forging western-CM collaboration
Weaknesses of Public Sector
• Need to overcome professional staff
resistance
• No experience in running CM services
• Rigid pay and benefit structure
• Apprehension of private sector on unfair
competition from the Hospital Authority
• No reliable data on costing for budgeting
purpose
Strengths of NGO Sector
• Long history of providing CM service
• Well established image of serving the
community and the poor
• Attracts community donations and support
• Competition among different NGOs for
government funding may lower the cost
• Flexibility in staff terms and salary
• Connections with Mainland for CM experts
Weaknesses of the NGO Sector
• CM service largely run as solo clinics of CM
practitioners
• No organized training and career structure
• Lack of know how in proper management
including pharmacy and clinical risk
management
• No access to western medicine counterparts
Private Sector Assessment
• Experience and track record of NGOs running
CM services
• Organizational leadership and commitment
• Proactive and learning attitude
• Sound financial health and internal
management
• Attractive proposal submitted
Tripartite Model
1. Each clinic attached to an HA hospital and
funded through HA
2. Run by an NGO through time-limited service
contract
3. In association with a local university for CM
research collaboration
• Phased approach – learn from pilots
Phase 1 - 2003
• Enhancing some existing, well-run CM clinics of
Schedule II hospitals (those managed by HA but
still owned by NGOs)
Tung Wah Hospital – Tung Wah Group – University of
Hong Kong
Yan Chai Hospital – Yan Chai Group – Hong Kong
Baptist University
Nethersole Hospital – Nethersole Group -The Chinese
University of Hong Kong
• Test case funding and contracting
Questions to Participants
• What are the benefits to government?
• What are the benefits to NGOs?
• How government can ensure achievement of
public aims:
1.
2.
3.
4.
Serving the poor
Ensure and improve quality
Ensure efficiency and cost-effectiveness
Forge collaboration between western and
Chinese medicine practitioners
New Era for CM Service in Hong Kong
Introducing Modern Management
Assessment Clinic
Modern Pharmacy
CM Information System
Innovation through NGO
• Flexibility of ranking and remuneration structure
for CM doctors, nurses, dispensers
• Relation of NGO and Mainland cities is key to
recruit top level CM Professors from China
• NGOs operate services outside the funded scope
(e.g. Special clinics, Acupuncture and Tui Na) for
revenue generation
• NGO seek donations for worthwhile activities
such as joint western and CM treatment/research
Government Control
Contracting and Franchising
• Stipulates mode of operation
• Stipulates standard fees for funded services
• Stipulates 20% free quota for the poor
• Stipulates guaranteed employment of 5 local
CM graduates per year per clinic
• Stipulates quality and quantity targets
• Mandatory use of a CM Information System
Expedient Completion of 14 Sites
• 2003 – Tung Wah Center, Yan Chai Center, Tai Po
Nethersole Center
• 2006 – Tang Shiu Kin Center, Tseung Kwan O
Center, Yuen Long Center, Yan Oi Tong Center, Ngau
Tau Kok Center, Kwong Wah Hospital Center, Tung
Wah Eastern Hospital Center
• 2007 – Ha Kwai Chung Center, Eastern Center,
Wong Tai Sin Hospital Center
• 2008 – Fanling Center, Buddhist Hospital Center
• 2009 – Shatin Center, West Kowloon Center
Other Collaborating Centers
• In 4 centers, the NGOs did not consider it
advantageous to receive HA funding and
comply with government rules
TWGHs - Kwong Wah Hospital, Tung Wah Eastern
Hospital, Wong Tai Sin Hospital
HKBU - Center at Queen Elizabeth Hospital
• But the 4 centers offer similar services to the
public and participate in the same IT platform
and training scheme
Benefits to Government
•
•
•
•
Short start up time
Less capital resource input
Capitalize on joint reputation of NGO and HA
Lowered contracting fee per clinic after tested
out market on first batch
• NGOs compete with each other through
quality
Benefits to NGOs
• Playing an active part in service provision rather
than passive (e.g. in western medicine)
• Service expansion with steady funding
• Government investment of facilities
• Revenue generation from flexibility to offer nonfunded services
• Enhancement of image and profile
• New areas for fund raising
• Benefit through collaboration with HA and
structured training of practitioners
Monitoring and Evaluation
• Through Clinic Management Committee
mechanism with tripartite representation and
HA representative
• Regular financial, human resources and
activities reporting
• Central committee on training of CM graduates
• Overall budget control, coordination and
service planning through an HA subsidiary
Take Home Messages
• Successful PPP schemes must bring benefit to
all involved parties
• Government leverages on the existing
strengths, experience and flexibility of NGOs
• NGOs leverage from steady funding and
management know how of government
• Public objectives must be clearly defined,
contracted for, measured and monitored
• Synergy should ensure 1+1 > 2
THANK YOU