Pharmaceutical Policy in Hong Kong : Defining an Evolving Area of Study

Background: Hong Kong as a developed economy in Asia still lags behind other advanced economies of the OECD in medicines regulation and the promotion of pharmacists’ professionalism. It lacks a significant local drug industry, and has only recently placed priority on cost-containment measures for pharmaceutical expenditures. This latter has increased politicization of pharmaceutical issues and sets the ground for a serious study of the policy processes affecting medicines and the stakeholders involved, both of which have hitherto not been researched locally. Objectives: To review pharmaceutical policy developments in Hong Kong and to identify the major policy debates regarding pharmaceuticals in recent years (2002-2006) with the view of studying the characteristics of these policy processes and activities. Methods: Documentary analysis method using minutes of meetings of the health services panel in the legislature and documents and position papers issued by various stakeholder groups. The framework for analysis is based on components of the policy cycle. Relevant policy process models and various theories are employed as tools to aid understanding of the policy activities. Results and Discussion: Pharmaceutical policy in Hong Kong is not concerned with issues of regulating the pharmaceutical industry, pharmaceutical R&D and patent protection, and state reimbursement of pharmaceutical payments which are characteristic priorities of policymaking in advanced economies. The ability of public policy to bring forward a new pharmaceutical regulatory framework and promote rational use of medicines is hampered by inadequate exercise of professionalism (muted pharmacist’ role due to lack of separation of prescribing and dispensing), an underdeveloped community pharmacy sector and insufficient integration of the various levels and sectors of healthcare provision. The pharmaceutical regulatory agency in Hong Kong remains conservative in outlook but is facing similar strain of challenge from the pharmaceutical sector despite the issues raised are of plain trade and business rather than industrial policy in nature. Description of the policy process is benefited by adapting the ‘stages heuristic’ framework. Both garbage can and policy streams models are useful in providing for an explanation of policy change. Conclusion: In the absence of an integrated framework, pharmaceutical policy formulation will likely remain ad hoc and continue to revolve around the ongoing wider discussions about health care reform. The problems faced by policymakers in formulating pharmaceutical policy in Hong Kong represent a different picture from Western countries where medicines policy in the latter naturally subsumes industrial policy, healthcare policy and public health policy under one rubric. This peculiarity may not be unique to Hong Kong but is perhaps reflective of other small jurisdictions as well