Dear Editor,

The issue of the Primary Healthcare Blueprint in December 2022 has driven some discussion in the community regarding how to reform and improve the healthcare system in Hong Kong. Some of the major issues that have since arisen are how the public can come to distinguish primary healthcare from curative care and secondary or hospital care, and even more importantly, how to make the public recognise the crucial role played by primary healthcare in Hong Kong’s healthcare system. This is especially difficult when most citizens, and even some healthcare professionals, have yet to fully understand what primary healthcare encompasses. The Chinese term “基層醫療” has perhaps caused even more confusion, as it may easily be misunderstood as medical care for the grassroot population.

This debate on naming does not only have an impact on the public’s understanding of this term, but also extends to the naming of the new primary healthcare authority. Eventually, the name “Primary Healthcare Commission” was selected to better reflect its roles and position, as compared with the Department of Health and the Hospital Authority. For non-government organisations which run district health centers, the discussion emphases more on social model like “wellbeing” instead of first contact for “healthcare system”.

Recently, the Hong Kong Practitioner, Journal of the Hong Kong College of Family Physicians, has received a letter to the editor expressing concern over the naming of various terms used for our primary healthcare system, and suggesting changing them to, for example, “Neighbourhood Health Network” (in replacement of “primary healthcare system”), and “Neighbourhood Health Service Referral Centres” (in replacement of “District Health Centres”). The author’s main worry is that the word “primary” carries an implication of being elementary, basic and simple, and may hence mislead the public into thinking that primary healthcare is a substandard healthcare system which is inferior to secondary/tertiary healthcare.

While it is agreed that naming plays an important role in shaping how the public perceives a new concept, I would, with respect, disagree with the suggestion of not using “primary healthcare”. Although it takes time and collaborative effort from the Government and healthcare service providers to drive the primary healthcare reform, the public will gradually come to recognise and appreciate the importance of primary healthcare when the system becomes more developed and starts to gain trust from the public. Moreover, primary healthcare is a commonly used and well-understood term among healthcare professionals across the globe, including mainland China and other Chinese-speaking countries and regions. As for community-based service providers like district health centers, the primary healthcare provided by them includes care for citizens' physical, psychological and social wellbeing, and they could function as a local health system which determines the standard service provision in the district, and district-based epidemiology.

The key move under the primary healthcare reform is to raise public awareness and educate the general public on the concept of preventive care, with the aim of shifting the culture of healthcare-seeking behaviour from a treatment-based to prevention-based approach. While a name which is more relatable to citizens may help, instilling confidence in the public in our primary healthcare system is the first and foremost issue to tackle. In order to achieve this, we need to ensure that our primary healthcare system is effective, well-regulated and comprehensive, with accessibility to secondary/ tertiary healthcare whenever necessary. At the same time, we need to strengthen the public’s understanding of the service scope and benefits of primary healthcare, through publicising its services and other means of public education. On the other hand, we will also strive to clarify common misconceptions about primary healthcare through such promotion and public education.

Family medicine is a well-established specialty in Hong Kong which has developed for over a few decades, and has a structured framework on driving better care at a primary healthcare level. As the key players in primary healthcare, we hope that family physicians could take up an even more active role in explaining and promoting the importance and benefits of primary healthcare to the public and to other healthcare professionals. With family physicians working in complement with the Primary Healthcare Office/Primary Healthcare Commission and other stakeholders, we trust that we can together achieve greater results efficiently from the current primary healthcare reform.

Yours sincerely,

Dr. Tony KH HA
Assistant Commissioner for Primary Healthcare