FAQ
The Chronic Disease Co-Care Pilot Scheme (CDCC Pilot Scheme) provides subsidy for the public
to conduct screening for and manage target chronic diseases, including hypertension and
diabetes mellitus, in the private healthcare sector via a "Family Doctor for All" and
multidisciplinary public-private partnership model coordinated by District Health Centres
(DHC) / District Health Centre Express (DHCE). The CDCC Pilot Scheme aims to facilitate
early detection and timely intervention of such chronic diseases and encourage
self-management by Scheme Participants, so as to help them better manage their chronic
diseases and prevent complications, as well as reduce the demand for public specialised and
hospital services.
The CDCC Pilot Scheme comprises a Screening Phase with or without a Treatment Phase for each
Scheme Participant. In the Screening Phase, Scheme Participants will be provided with
screening services including medical consultation and assessment by Family Doctor and
laboratory investigation services, followed by the making of diagnosis and selection of an
appropriate management plan. In the Treatment Phase, Family Doctors will provide medical
consultation and medication, as clinically indicated, for eligible Scheme Participants.
Based on the diagnosis and clinical condition of a Scheme Participant, nurse consultation,
allied health services and laboratory investigation services will also be provided as
appropriate.
Private doctors are required to meet the following criteria for enrolment in the CDCC Pilot
Scheme:
- Practising in a private healthcare facility;
- Being included in the general register in accordance to Section 14 or Section 14A of the Medical Registration Ordinance (Cap. 161 of the laws of Hong Kong) and holding a valid practising certificate;
- Being a healthcare provider enrolled in the Electronic Health Record Sharing System (eHRSS); and
- Being listed in the Primary Care Directory (PCD)
Interested private doctors may enrol in the CDCC Pilot Scheme either by invitation from the
Government or through his / her own volition online through the eHRSS.
Yes. If private doctors are not enlisted on the PCD, they may submit an application online
at www.pcdirectory.gov.hk, or through the eHealth System (Subsidies) if they have already
enrolled in the Health Care Voucher Scheme and / or the Vaccination Subsidy Scheme and / or
Residential Care Home Vaccination Programme. For details, please contact the PCD Hotline at
3576 3658 or email to pho@healthbureau.gov.hk for further assistance.
To enrol in the CDCC Pilot Scheme as a Scheme Participant, an individual must meet the
following criteria:
- is a holder of a valid Hong Kong Identity Card within the meaning of the Registration of Persons Ordinance (Cap. 177), except for those who obtained a Hong Kong Identity Card by virtue of a previous permission to land or remain in Hong Kong granted to him / her and such permission has expired or ceased to be valid; or a holder of a valid Certificate of Exemption within the meaning of the Immigration Ordinance (Cap.115);
- is aged 45 or above;
- has no hypertension / diabetes mellitus, nor related symptom(s), such as polyuria, polydipsia or weight loss; and
- has registered as a DHC / DHCE member and agrees to share his/her data in the eHRSS with related service providers.
In the initial phase, eligible individuals can enrol in the CDCC Pilot Scheme at DHC / DHCE.
In the later phase, eligible individuals can also enrol in the CDCC Pilot Scheme at the
clinics of Family Doctors. Details will be announced by the Government in due course.
Yes. Online training video and user guides will be provided. Family Doctors can download the
guides from the eHRSS.
Scheme Participants can select a suitable Family Doctor by searching the website of CDCC
Pilot Scheme, which provides the list of Family Doctors with their essential information
including practice district, service charge under the CDCC Pilot Scheme and participation in
other Government subsidised primary healthcare programmes e.g. Elderly Healthcare Voucher
Scheme.
If a Scheme Participant wants to choose his / her existing regular attending private doctor
who is not a enrolled Family Doctor of the CDCC Pilot Scheme, the Scheme Participant can
contact the DHC / DHCE and the DHC / DHCE will invite that private doctor to join the CDCC
Pilot Scheme before the Scheme Participant can be paired with the named doctor.
Scheme Participants shall visit DHC or DHCE for the pairing process. DHC / DHCE staff will
provide a list of eligible doctors for Scheme Participant to select as his / her Family
Doctor, according to his / her own choice. DHC / DHCE staff will not recommend or assign any
Family Doctor to the Scheme Participant. After successful pairing, Scheme Participants will
be arranged to receive screening
and treatment by the selected Family Doctor.
For the Screening Phase, a Family Doctor must accept any Scheme Participant who has been
referred to him / her by DHC / DHCE to participate in the CDCC Pilot Scheme. Acceptance of
Scheme Participants in the Treatment Phase is subject to mutual agreement between the Family
Doctor and the Scheme Participants.
In general, Family Doctors do not need to indicate any quota for accepting Scheme
Participants. In the event that the Family Doctor's clinic is temporarily unavailable for
accepting new Scheme Participants due to interruption or suspension of services, the Family
Doctor should inform the Programme Office immediately via email at
cdccdoctor@healthbureau.gov.hk or fax to 3427 9359 and provide the details of the clinic,
the reason(s) for service interruption or suspension and the expected date, if possible, for
resumption of services.
Family Doctors newly enrolled in the CDCC Pilot Scheme or updates to details of existing
Family Doctors on the list would be publicised timely on an on-going basis. More details
would be announced later.
A Family Doctor may terminate his / her participation in the CDCC Pilot Scheme by giving not
less than 90 days' written notice, to the Programme Office via email to
cdccdoctor@healthbureau.gov.hk or fax to 3427 9359, and to the Scheme Participants under his
/ her care. A Family Doctor may, without terminating his / her participation in the CDCC
Pilot Scheme, terminate the doctor-patient relationship with any specific Scheme Participant
by giving not less than 30 days' written notice, to the Programme Office and that specific
Scheme Participant.
Scheme Participants are encouraged to maintain a long term relationship with the paired
Family Doctor. However, if he / she does want to change their pair Family Doctor, he / she
may submit the request to DHC / DHCE for arrangement. The request will be handled on a
case-by-case basis.
Family Doctors may contact the CDCC Pilot Scheme's hotline at 2157 0500 for assistance. The
hotline operates from 9:00am to 9:00pm Monday to Saturday. If the line is busy or if the
call
is made outside of operating hours, Family Doctors may leave a voicemail and we will respond
to the inquiry as soon as possible during our office hours.
The service fee for the Screening Phase is the aggregate amount of a fixed one-off
Government subsidy of $196 payable upon the completion of screening, and the one-off
co-payment of $120 charged by the Family Doctor and payable by the Scheme Participant at
his / her first subsidised medical consultation visit of the Screening Phase.
The Screening Phase covers medical consultation and assessment in relation to screening for
hypertension and diabetes mellitus, reviewing investigation result(s), and making diagnosis
by the Family Doctor. Before the completion of the Screening Phase, a Family Doctor should
ensure that the following are documented in the CDCC IT Platform:
- Attendance record for at least one face-to-face subsidised medical consultation visit
- Completed mandatory fields for medical consultation record
- Investigation result(s)
- Diagnosis
- Selected management plan
No. The service fee is a one-off fee, irrespective of the number of medical
consultations provided to the Scheme Participant.
No. The criteria for receiving Government subsidy in the Screening Phase is to have at least
one face-to-face medical consultation for attendance record. However, any other medical
consultations can be done by phone or online.
For any Scheme Participant (1) with normal results; OR (2) is diagnosed with prediabetes
with HbA1c 5.7% - 5.9% or FPG 5.6 mmol/L – 6 mmol/L but without hypertension
The Scheme Participant will re-enter the Screening Phase in three years' time. The Family Doctor should arrange for medical consultation visit and laboratory investigation(s) for the Scheme Participant once every 3 years (or more frequently if clinically indicated).
For any Scheme Participant diagnosed with prediabetes with HbA1c 6.0% - 6.4% or FPG 6.1 mmol/L – 6.9 mmol/L but without hypertension
The Family Doctor should arrange for laboratory investigation(s) annually (or more frequently if clinically indicated) and any additional laboratory investigation(s) as necessary during medical consultation visit(s) included in the Treatment Phase.
After the laboratory investigation result(s) become available, the Family Doctor should explain the result(s) to the Scheme Participant and manage the Scheme Participant following the Operation Manual for Family Doctors of the CDCC Pilot Scheme as posted on the website of the CDCC Pilot Scheme.
The Scheme Participant will re-enter the Screening Phase in three years' time. The Family Doctor should arrange for medical consultation visit and laboratory investigation(s) for the Scheme Participant once every 3 years (or more frequently if clinically indicated).
For any Scheme Participant diagnosed with prediabetes with HbA1c 6.0% - 6.4% or FPG 6.1 mmol/L – 6.9 mmol/L but without hypertension
The Family Doctor should arrange for laboratory investigation(s) annually (or more frequently if clinically indicated) and any additional laboratory investigation(s) as necessary during medical consultation visit(s) included in the Treatment Phase.
After the laboratory investigation result(s) become available, the Family Doctor should explain the result(s) to the Scheme Participant and manage the Scheme Participant following the Operation Manual for Family Doctors of the CDCC Pilot Scheme as posted on the website of the CDCC Pilot Scheme.
The number of subsidised medical consultation visits a Scheme Participant is entitled to is
subject to his / her admitted management programme for his / her diagnosis. Scheme
Participants diagnosed with
hypertension and / or diabetes mellitus are entitled to a maximum of 6 subsidised medical
consultation visits per year, while those diagnosed to have prediabetes with HbA1c 6.0% -
6.4% or FPG 6.1 mmol/L – 6.9 mmol/L having no hypertension are entitled to a maximum of 4
subsidised medical consultation visits per year.
The service fee for the Treatment Phase is the aggregate amount of a fixed Government
subsidy for one subsidised medical consultation visit in the Treatment Phase, and the
co-payment determined by the Family Doctor and payable by the Scheme Participant for that
subsidised medical consultation visit. The service fee for each subsidised visit covers the
medical consultation and assessment, medication (if any) and related referral.
On enrolment to the CDCC Pilot Scheme, a Family Doctor shall inform the Government of the
amount of co-payment he / she will charge each Scheme Participant for each subsidised
medical consultation visit during the Treatment Phase. This co-payment determined by the
Family Doctor may differ from the Government recommended co-payment fee.
No. Scheme Participants must go through Screening Phase before proceeding to the Treatment
Phase. The Screening Phase is an essential step to ensure a correct diagnosis is made and an
appropriate management plan can be arranged for Scheme Participants.
A "Participant Programme Year" is each 12-month period in which a Scheme Participant is
enrolled in the CDCC Pilot Scheme, and is counted from the date on which the Scheme
Participant is admitted into a management programme of the Treatment Phase based on his /
her diagnosis, and recounted on the same date each year (e.g. if a Scheme Participant joined
the CDCC Pilot Scheme on 1 November 2023, the next "Participant Programme Year" will be
counted from 1 November 2024).
Where a Scheme Participant's clinical condition changes during the Treatment Phase, the
Family Doctor will make a new diagnosis. If a Scheme Participant's diagnosis is changed, the
start date for his / her "Participant Programme Year" will be reset from the date on which
the new diagnosis is made.
No. There is no Government subsidy available for subsidised medical consultation visit
conducted through phone or online means. The criteria for receiving Government subsidy in
the Treatment Phase is to have attendance record(s) for face-to-face consultation(s).
Yes. Family Doctors should select the appropriate management programme based on the Scheme
Participant's diagnosis. In case of any change in the Scheme Participant's clinical
condition during the Treatment Phase which warrants a change in his / her diagnosis, the
Family Doctor may change the management programme accordingly. For details, please refer to
the Operation Manual for Family Doctors of the CDCC Pilot Scheme as posted on the website of
the CDCC Pilot Scheme.
To support and empower Family Doctors in long-term management of Scheme Participants, the
Government has developed a bi-directional referral mechanism with the Hospital Authority
(HA) involving seven HA Clusters under the CDCC Pilot Scheme. Based on the pre-defined
criteria, if a Scheme Participant is assessed by a Family Doctor as having clinical needs
(such as undesirable disease control or complications), the Family Doctor can arrange for
the Scheme Participant to receive a one-off specialist consultation at a designated Medicine
Specialist Out-patient Clinic of the HA according to the guidelines. For details of the
criteria required to arrange for a specialist consultation under this mechanism, please
refer to the Operation Manual for Family Doctors of the CDCC Pilot Scheme as posted on the
website of the CDCC Pilot Scheme.
Upon the Scheme Participant's attendance of the specialist consultation, the HA specialist will provide the Family Doctor with a care plan based on the Scheme Participant's clinical condition. The Family Doctor will then monitor the clinical condition of the Scheme Participant as appropriate and take follow-up actions in accordance with the care plan.
If none of the conditions required for referral under this mechanism is met, but the Family Doctor nonetheless determines that specialist consultation / treatment is necessary, he / she may refer the Scheme Participant to receive secondary care services at specialist out-patient clinics under HA following prevailing mechanism.
Upon the Scheme Participant's attendance of the specialist consultation, the HA specialist will provide the Family Doctor with a care plan based on the Scheme Participant's clinical condition. The Family Doctor will then monitor the clinical condition of the Scheme Participant as appropriate and take follow-up actions in accordance with the care plan.
If none of the conditions required for referral under this mechanism is met, but the Family Doctor nonetheless determines that specialist consultation / treatment is necessary, he / she may refer the Scheme Participant to receive secondary care services at specialist out-patient clinics under HA following prevailing mechanism.
A Scheme Participant is only entitled to use one subsidised medical consultation visit quota
per day. Additional medical consultation(s) on any single day is / are not covered under the
scope of the CDCC Pilot Scheme and are considered the private arrangement between the Family
Doctor and Scheme Participant. Scheme Participants will have to pay the full costs specified
by Family Doctors, out-of-pocket for such additional service(s) or treatments.
Yes. Scheme Participants can seek care for both chronic and episodic illnesses at any given
subsidised medical consultation visit.
Services that are not specifically covered under the CDCC Pilot Scheme are considered the
private arrangement between the Family Doctor and Scheme Participant. Scheme Participants
have to pay the full costs specified by the Family Doctor, out-of-pocket, for any treatment
or medical services (including medical consultation, laboratory investigation services,
medication and referral etc.) provided.
It is desirable for Family Doctors to have relieving service arrangement in place during
their absence. The assigned relieving doctor(s) must have been enrolled to the CDCC Pilot
Scheme as a Family Doctor.
Yes, as long as the laboratory investigation results are issued within 6 months before the
first subsidised medical consultation visit in the Screening Phase.
The turnaround time for investigation services may vary depending on the investigation item
and the designated investigation service provider conducting the test. Generally, the Family
Doctor will receive the investigation results electronically through CDCC IT Platform once
available.
Upon referral by their Family Doctors, Scheme Participants can receive relevant laboratory
investigation and / or ECG services at designated investigation service providers, which is
assigned by Government.
Yes. Scheme Participants may choose to use investigation services other than the Government
designated investigation service providers, however Scheme Participants will have to pay
out-of-pocket for the full costs incurred without Government subsidy.
Yes, the Family Doctor can reject an investigation result issued by Government designated
investigation service providers during either the Screening or Treatment Phases. If the
Family Doctor considers that the result does not fulfill the requirements specified in the
investigation request, they can request the investigation service provider to repeat the
test or conduct additional investigation as indicated. If the investigation cannot be
completed according to the explanation provided by the investigation service provider, the
Family Doctor should assess the importance of the incomplete item. If it is deemed essential
for the investigation, the Family Doctor should issue a new investigation service request
and instruct the Scheme Participant to repeat the investigation. On the other hand, if the
incomplete item is not considered crucial to the investigation, the Family Doctor can
proceed with clinical management.
Designated DHC / DHCE staff can review the management plans of Scheme Participants through
the CDCC IT Platform. For special issues related to Family Doctor pairing or the management
plans of Scheme Participants, Family Doctors may call or email the designated DHC / DHCE
staff.
Family Doctors need to print a referral letter for the Scheme Participants and / or fax the
referral letter to the responsible DHC / DHCE. DHC / DHCE will make appointments with allied
health professionals for the Scheme Participants in accordance with their assigned
management plans and recommendation from Family Doctors.
Yes. Scheme Participants may choose to use allied health services other than the Government
designated service providers, however Scheme Participants will have to pay out-of-pocket for
the full costs incurred without Government subsidy.
Based on a Scheme Participant's clinical indication, the Family Doctor may prescribe
medications listed under the basic tier of the "Specified Drugs" list for chronic diseases
with no extra charges to the Scheme Participant. In the case of episodic illnesses, the
Family Doctor may prescribe medications under the "Specified Drug" list, and / or up to 3
days of medications outside the "Specified Drug" list, with no extra charges to the Scheme
Participant. For the Specified Drugs list, Family Doctors can refer to the Specified Drugs
list as posted on the website of the CDCC Pilot Scheme.
Family Doctors may use their own clinic's drugs or purchase "Specified Drugs" from
designated drug suppliers at discounted prices offered under the CDCC Pilot Scheme. Family
Doctors can make orders, view order status, check remaining order balance and review past
orders using the CDCC IT Platform.
Family Doctors can start ordering "Specified Drugs" via the CDCC IT Platform after being
paired with the first Scheme Participant. A "Starter Pack" comprising all drugs listed on
the "Specified Drugs" list will then be available for purchase by the Family Doctors.
Family Doctors and the drug suppliers should contact each other directly in case of any
issue, including delivery error or drug recall, late delivery, shelf-life or dispute
regarding the "Specified Drugs" delivered by the drug suppliers. All payments for the
"Specified Drugs" should be paid by Family Doctors to the drug suppliers directly.
Yes. The Government will specify the maximum quantity of "Specified Drugs" which a Family
Doctor may purchase in a specified period at discounted prices offered under the CDCC Pilot
Scheme. It is important for Family Doctors to input the prescription record for each
subsidised medical consultation visit onto the CDCC IT Platform so that the system can
deduce the quantity of drugs available for purchase and whether the Family Doctor can
receive the quarterly Government subsidy for medication.
Subject to a Scheme Participant's clinical needs and the mutual agreement between the Scheme
Participant and the Family Doctor, the Family Doctor may, at a subsidised medical
consultation visit, prescribe medication for a duration that he / she determines to be the
most appropriate for the Scheme Participant, based on his / her clinical judgment.
The Family Doctor may prescribe for a duration that he / she determines to be the most
appropriate for the Scheme Participant, based on his / her clinical judgment. The service
fee for each subsidised medical consultation visit covers medications for episodic illnesses
up to a maximum of 3 days. If the duration of prescribed drugs for episodic illness is
beyond 3 days and not within the list of "Specified Drugs", the Scheme Participant has to
pay the full costs of such additional
service(s) out-of-pocket.
Depending on whether medication(s) for chronic diseases under the basic tier of "Specified
Drugs" is / are prescribed, Family Doctors may receive a quarterly Government subsidy for
medication. A fixed amount of $105 per Scheme Participant will be reimbursed to Family
Doctors, at a maximum frequency of once per quarter and four times per calendar year.
Based on a Scheme Participant's clinical condition, Family Doctors can prescribe any
medication outside of the "Specified Drugs" list. Family Doctors may charge the Scheme
Participant for prescribing such medications upon mutual agreement with the Scheme
Participant, except for those medications for episodic illnesses (e.g. common cold, flu or
cough etc.) prescribed up to 3 days, which are covered under the CDCC Pilot Scheme.
For the Screening Phase, a Family Doctor can charge the one-off co-payment of $120 at the
first subsidised medical consultation visit. For the Treatment Phase, the Family Doctor can
charge the co-payment determined by him / her at each subsidised medication consultation
visit.
A Family Doctor may adjust the amount of co-payment he / she had determined under Treatment
Phase on an annual basis (details of which will be announced by the Government) and such
adjustments shall not take effect before the effective date announced by the Government.
For the Screening Phase, the Government subsidy is a fixed one-off amount of $196. For the
Treatment Phase, the Government subsidy amount is $166 for each subsidised medication
consultation visit.
Yes. Scheme Participants are entitled to use the electronic vouchers under the Government's
Elderly Healthcare Voucher Scheme towards the settlement of the co-payment charged by
Family Doctors, provided that the Family Doctor accepts Elderly Healthcare Vouchers.
Family Doctors can submit claims of subsidy for subsidised medical consultation visit,
quarterly medication fee and incentive payment (if any) under the CDCC IT Platform on
the 1st to
10th of every month. Submitted claims shall be verified by the Government and
subject to
verification and acceptance of the claim, payment shall be made by the Government within 30
clear working days from the date of which the submitted claims are to the satisfaction of
and not disputed by the Government.
Incentive targets are applicable to the Treatment Phase only and the specific target
parameters depend on whether the Scheme Participants are diagnosed with (i) diabetes
mellitus; (ii) hypertension; (iii) hypertension + diabetes mellitus; or (iv) hypertension +
prediabetes.
Family Doctors who have a certain percentage of Scheme Participants under his / her care who
are able to achieve health incentive targets (i.e. target parameters) in regards to blood
sugar and blood pressure levels, will be eligible to receive incentive payments. Family
Doctors can refer to the website of the CDCC Pilot Scheme for details of the target
parameters and the corresponding percentage required to achieve the prerequisite.
The incentive payment mechanism will only consider Scheme Participants that have completed
their second participant programme year or beyond, and have met their individual achievement
requirements. The incentive payment is calculated as 15% of the number of subsidised visits
attended by target-achieving Scheme Participants times the sum of Government subsidy per
subsidised
visit and recommended co-payment fee.
If the Family Doctor has met the criteria to be eligible to receive an incentive payment,
the amount receivable by a Family Doctor is calculated at the end of each calendar year.
Details of the payment cycle would be announced by the Government in due course.
Yes. All Scheme Participants and Family Doctors are required to participate in the eHRSS so
as to enable sharing of clinical information between the private and the public sectors. For
details, please visit the eHRSS website at https://www.ehealth.gov.hk or contact the
Healthcare Provider eHRSS hotline at 3467 6230 for assistance.
For the Screening Phase, the Scheme Participant's attendance record, medical assessment
result(s), laboratory investigation result(s), diagnosis, selected management plan and
payment record are required to be documented on the CDCC IT Platform. For the Treatment
Phase, the Scheme Participant's attendance record, medical assessment and management,
payments record and, where applicable, medication record and laboratory investigation
result(s) are required to be documented on the CDCC IT Platform.
In case of any difficulty accessing the eHRSS platform, Family Doctors can call the
Healthcare Provider eHRSS hotline at 3467 6230 for assistance. For information on how to use
the CDCC IT Platform, Family Doctors can either read user documents from the eHRSS, or call
the CDCC Pilot Scheme hotline at 2157 0500 for assistance.
The Family Doctor can request a new SMS OTP by pressing 'Resend'. If the problem persists,
the Family Doctor can contact the Healthcare Provider eHRSS hotline at 3467 6230 for
assistance.
The Family Doctor can update his / her contact details, such as telephone number and
communication means, via the eHealth application or the eHealth hotline for general public
at 3467 6300 after identity verification.
If a Family Doctor has any updates / changes to make to the information he / she previously
provided for enrolment, they must inform the Programme Office immediately via email (at
cdccdoctor@healthbureau.gov.hk) or by fax (to 3427 9359). Upon receiving such request, the
Programme Office will proceed with updating the information on the CDCC IT Platform.
Family Doctors should also inform the Primary Healthcare Office of corresponding update of
such information, by using the PCD online service provider platform. For enquiries about
PCD, please contact the PCD Hotline at 3576 3658 or by email to pho@healthbureau.gov.hk for
further assistance.