Healthcare vouchers for better elderly services? Input from private healthcare service providers in Hong Kong

Hong Kong's health system comprises parallel and segmented public and private financed and provided sectors, in which access to the limited public primary healthcare has been an issue. This gave the government the impetus to implement the Elderly Healthcare Voucher Scheme since 2009, providing Hong Kong resident aged 65 and above an annual entitlement of HK$2,000 to purchase private primary healthcare. This was to reduce the demand for public healthcare and encourage the use of private preventive care and chronic disease management. To evaluate the effectiveness and impact of the voucher scheme, in-depth understanding from the providers' perspectives on implementation barriers and facilitators was studied. The perspectives of 33 service providers were sought through five focus group discussions and seven telephone interviews between 2016 and 2017. Mixed sampling strategies were used, and the discussion covered three main areas: (a) factors that affect the impact of voucher scheme in bridging the private and public primary healthcare sector; (b) perceived barriers to participation in the voucher scheme and (c) potential enhancement of the voucher scheme. Participants agreed that the voucher scheme encouraged uptake of private primary care for acute episodes, but not for chronic disease management and rehabilitation due to inadequate financial entitlements and the elderly persons' lack of knowledge on the services covered. Low financial incentives, tedious administrative work and inadequate communications were identified as barriers for enrolment. The voucher scheme has resulted in increased utilisation of private primary healthcare but has not reduced the demand for public primary healthcare. Fundamental questions remain about the scheme's potential role in improving universal health coverage and financial sustainability which are related to the program design and to whether this is the better mechanism, or a complementary mechanism to address some of the more complex health system priorities including better chronic disease management.