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EdUHK Policy Research Informed Health Care Reform in Mainland China and Hong Kong

The healthcare systems of the mainland and Hong Kong face similar challenge of spiralling costs in the face of increasing demand from a more prosperous and aging population, and a surge in non-communicable diseases. Hong Kong government reforms aim to reduce the burden on the over-stretched public healthcare system. The public policy research by Dr Alex He Jingwei, Associate Professor and Associate Head (Research and Development) at the Department of Asian and Policy Studies, The Education University of Hong Kong, has contributed to knowledge informing large-scale reforms in both mainland China and Hong Kong, and generated public debate. His work provided a significant reference in a major government-supported reform blueprint for the mainland’s healthcare system, much of it now being implemented in the State Council’s 13th Five-Year Plan (2016-2020), engagement with policymakers, and media engagement in mainland China and Hong Kong, reaching an audience of at least a billion people.

In the past decade, healthcare costs in China have grown 5 to 10 percentage points higher than GDP growth. Without reforms, healthcare costs are expected to increase five-fold by 2035 and account for over 9% of GDP, up from 5.6% in 2014. Therefore, Dr He’s research has focused on healthcare costs and sustainability in Hong Kong and the mainland China. He has conducted research across three main areas which have played an important role in informing both policy and the public debate: (1) doctor-patient relationships in mainland China; (2) healthcare governance in mainland China; and (3) private health insurance in Hong Kong. 

In a survey of 506 doctors in Shenzhen, Dr He found that when the doctor-patient relationship was poor, doctors were more likely to practice “defensive medicine”, involving over-prescription of drugs and diagnostic tests to avoid liability and future medical disputes. These practices have had a negative impact on the healthcare system’s capacity and sustainability. 

In his research on healthcare governance in mainland China, Dr He identified how the limited capacity of the social health administration impeded policy reforms, in particular practices desired by policymakers for cost-effective strategic and third-party purchasing of health care funded by universal social health insurance. While the government set up a broad network for social health insurance, poor administrative capacity has prevented the desired outcomes, such as cost containment. He developed further insights into healthcare in mainland China through a comparative review of health financing reforms in Hong Kong and Singapore.

In Hong Kong, spending on healthcare is predicted to take up as much as 27% of the government budget by 2033, as the population ages and relies on the public service for about 90% of inpatient care. Dr He has conducted research to inform the planning of health financing and long-term care reforms by conducting surveys on the public’s attitude to the government’s preferred policy option for voluntary healthcare insurance and their willingness to pay for private insurance. 

Dr He’s research in mainland China has improved understanding of areas of the healthcare system that need reform and has had a significant impact on policy design and implementation. A blueprint for reforms, from the high-profile study conducted for the World Bank, the World Health Organisation, and the Chinese Government, “Healthy China: Deepening Health Reform in China, Building High-Quality and Value-Based Service Delivery”, cited six of his articles, making him one of the most extensively cited researchers informing the study. The report has been highly valued by the Chinese government as an important reference for health policy and reform, as evidenced by Liu Yandong, Vice Premier of the State Council of China.

In Hong Kong, Dr He’s studies informed policy debate, having an impact on government and industry understanding of public attitudes to health finance reform, and informing policy making. A senior policymaker at the Food and Health Bureau invited him to present and discuss the findings of his research on voluntary health insurance. Dr He was also invited to brief the Hong Kong Federation of Insurers, a key stakeholder in health financing reform.

Dr He has contributed to improving public awareness of health-reform options through extensive media engagement in Hong Kong and mainland China. His research on the doctor-patient relationships and broad health policy reform options achieved local and international media attention, reaching an audience of more than one billion. 


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