A Tale of 3 Asian Cities: How is Primary Care Responding to COVID-19 in Hong Kong, Singapore, and Beijing?

Samuel Y. S. Wong; David H. Y. Tan; Yun Zhang; Anbumalar Ramiah; Xuejun Zeng; Eric Hui; Doris Y. L. Young

doi:10.1370/afm.2635

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Table 1.

COVlD-19 Cases, Deaths, and Viral Tests by City, as of July 15, 2020

Measure	Hong Kong	Singapore	Beijing
Population, in millions	7.45	5.70	21.54
Cases
Confirmed/probable cases, No.	1,589	46,878	929
Imported cases, No. (%)	912 (57.4)	623 (1.3)	174 (18.7)
Local cases, No. (%)	677 (42.6)	46,255 (98.7)	755 (81.3)
Total cases per 100,000 population, No.	21.33	822.42	4.31
Deaths
Fatal cases, No.	10	27	9
Total fatal cases per 100,000 population, No.	0.13	0.47	0.04
Total fatal cases per 100 cases, No.	0.63	0.06	0.97
Viral tests^{^a}
Total tests performed, No.	442,256	1,009,532	>11,000,000
Total tests performed per 100,000 population, No.	5,936	17,711	>51,000
Total cases per 1,000 viral tests, No.	3.59	46.44	<0.08

COVID-19 = coronavirus disease 2019.
Note: All data for Hong Kong from Centre for Health Protection³; all data for Singapore from Ministry of Health⁵; all data for Beijing from Sina International News⁶ and Xinhua News Agency.⁷
↵a Hong Kong: total number of COVID-19 viral tests performed was updated on July 14, 2020. Singapore: total number of COVID-19 viral tests performed was updated to July 13, 2020. Beijing: lockdown on 54 communities was lifted at this time.⁷

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Table 2.

Primary Care Structure in Each City

Measure	Hong Kong	Singapore	Beijing
Registered physicians
Registered physicians, No.	14,700¹⁰	14,334	115,771
Primary care physicians working in public health centers, No.	429¹³	455	32,298^{^a}
Private primary care physicians, No.	2,476¹⁴	1,434	…
Public primary care health centers, No.	73⁹	20	10,306
Ratio of public to private outpatient visits	30:70¹⁵	20:80	…
Structure of public primary care health centers
Location	Independent clinics or within public hospital grounds	Independent buildings or within integrated developments in the community	Mostly independent clinics
Funding	Public funding	Public funding with copayment in cash out of pocket or through Medisave	Public funding
Practice size	2 to 20	10 to 30	At least 2 to 6 (flexible based on number of residents in community)
Relationship to public health	Separate entities	Separate entities	Integrated system
Referral process	Referral to specialist outpatient clinics of public or private clinics/hospitals	Referral to specialist outpatient clinics of public hospitals	Referral to specialist (including physicians with GP certificates) outpatient clinics of hospitals
Structure of private primary care health centers
Location	Independent clinics or within private hospital grounds	Mainly independent clinics	…
Funding	Out of pocket or insurance	Out of pocket, insurance (self or employer), or public funding (CHAS)	…
Practice size	Solo or small group	Solo or small group	…
Relationship to public health	Separate entities	Separate entities	…
Referral process	Referral to specialist outpatient clinics in public or private clinics/hospitals	Referral to specialist outpatient clinics in private clinics/hospitals or (only for those on CHAS) public clinics/hospitals	…

CHAS = Community Health Assistance Scheme; GP = general practitioner.
Note: all data for Singapore from Singapore Medical Council¹¹; all data for Beijing from Beijing Municipal Health Commission Policy Research Center.¹²
↵a The figures are total numbers (both the public and the non-public included). The primary care system in Beijing is largely publicly funded. Only a small number of institutions are non-publicly funded, and to our knowledge, there has not been any official statistics released on this part.

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The Article in Brief

A Tale of 3 Asian Cities: How is Primary Care Responding to COVID-19 in Hong Kong, Singapore, and Beijing?

Samuel Y. S. Wong , and colleagues

Background Despite having some of the densest living spaces and the highest number of international visitors, Hong Kong, Singapore, and Beijing have utilized their respective primary health care systems to keep their COVID-19 cases and deaths relatively low.

What This Study Found Researchers studied the primary health care systems in the three cities to identify features of each system that other cities can use as examples to prepare for and prevent deaths in future health crises. Wong et al write that all three cities have made use of primary care in performing public health surveillance and primary care functions

Implications

Primary care is an indispensable part of any health system and can play an important role in addressing future infectious disease outbreaks when it is supported, engaged, and integrated with other parts of a health system.