The ecology of health care in Hong Kong

To better understand the distribution of resources and health care consumption patterns in different geo-ethnic and socio-economic settings, we sought to describe the patterns of illness, care-seeking behavior and health services utilization in Hong Kong compared to the US and UK. Data were derived from the 2002 Hong Kong Thematic Household Survey covering 31,762 non-institutional and institutional residents, representing 6,504,255 persons after applying population weights. Of 1000 individuals during a 1-month period, 567 reported symptoms, 512 of whom considered seeking health care. Four hundred and forty persons visited western allopathic medical practitioners, with 372 (84.5%) in primary care and 68 (15.5%) in specialty care. There were 54 visits to traditional Chinese medical practitioners and 16 emergency room episodes. Seven individuals were hospitalized in community hospitals and on average one in 1000 were admitted to a tertiary medical center. Ninety out of the 567 who experienced symptoms undertook self-management strategies, which included over-the-counter western allopathic medications (n=54) or traditional Chinese remedies (n=14) or both (n=2), dietary modification (n=1) and rest (n=15). We have mapped the ecology of health care in Hong Kong. Monthly prevalence estimates were remarkably similar to US figures for hospital-based events, whereas there was evidence of apparent, substantial "over-consumption" of ambulatory, community-based care. Our results also indicate that the local community's care-seeking orientation still very much favors western allopathic medicine over traditional Chinese therapy, at least for acute illness episodes.     

SARS-related perceptions in Hong Kong

To understand different aspects of community responses related to severe acute respiratory syndrome (SARS), 2 population-based, random telephone surveys were conducted in June 2003 and January 2004 in Hong Kong. More than 70% of respondents would avoid visiting hospitals or mainland China to avoid contracting SARS. Most respondents believed that SARS could be transmitted through droplets, fomites, sewage, and animals. More than 90% believed that public health measures were efficacious means of prevention; 40.4% believed that SARS would resurge in Hong Kong; and approximately equals 70% would then wear masks in public places. High percentages of respondents felt helpless, horrified, and apprehensive because of SARS. Approximately 16% showed signs of posttraumatic symptoms, and approximately equals 40% perceived increased stress in family or work settings. The general public in Hong Kong has been very vigilant about SARS but needs to be more psychologically prepared to face a resurgence of the epidemic.     

Economic development and the health care system in Hong Kong

This article describes parallel developments of the Hong Kong economy and its health care system. The purpose is to illustrate how the Hong Kong health system evolved in response to external and internal pressures generated by economic prosperity. The Hong Kong system illustrates the importance of clear policy making in the face of these pressures. In particular, issues of investment, financing and distribution of health services are examined in relation to hospital cost control and service accessibility. In the past, health care costs in Hong Kong have been controlled at the expense of limited accessibility of health services. At present, Hong Kong policy-makers are faced with the challenge of maintaining a sharp focus on cost control as they face pressure to expand and improve health care coverage for the citizens. So far they have responded by emphasizing management efficiency through reorganization. It remains to be seen whether this strategy can be successful without passing increased health care costs to the consumers.     

Quality of life of mental health consumers in Hong Kong: Analysis of service perceptions

Objectives Successful psychiatric rehabilitation entails fostering overall quality of life of individuals recovering from severe mental illnesses. Understanding how service-related perceptions may be related to quality of life can be useful in improving the effectiveness of community-based care. This study investigated the quality of life of mental health consumers using a service-oriented paradigm. Methods 162 mental health consumers from community-based psychiatric rehabilitation centers were interviewed. Analyses were conducted to investigate the relationships between service perceptions (perceived treatment coercion, rehabilitation needs, and continuity of care) and quality of life. Results Physical health quality was negatively related to rehabilitation needs. Mental health quality was negatively related to both rehabilitation needs and poorer continuity of service. Life satisfaction was negatively related to poorer continuity of service and higher perceived treatment coercion. Conclusions This study highlighted the significance of service perceptions in the well-being of individuals with severe mental illness.     

香港医疗融资方案之探讨

如同其他国家一样,香港正面对人口增长及老化、市民对医疗服务期望高、新医疗科技成本较高的问题,由此而生的问题是香港沿用多年的医疗体制能否长期得以维持?香港的公立医疗服务能否以有限的财政资源应付无尽的需求?香港政府聘用了哈佛顾问小组,就香港的医疗体制和融资方式作出检讨。该文将就香港的医疗体制及融资方案问题作出探讨。     

From residential care to residential care — the case of Hong Kong

Permanency planning has been a major concern in the child care field in the West for almost two decades. The first comprehensive study on residential child care in Hong Kong found that a substantial proportion of the children in care had been transferred from one residential facility to another. Their parents suffered from more health, economic and social maladjustment problems than parents of the other children in care. Can this account for the length of time these children were to spend in care? Comparison made among the children involved in four types of movement reveals significant differences in age at admission and parenting deficiency. This reflects the implicit yardstick employed in placing children in different care settings, and the systemic function of institutional care. The concept of permanency planning is reexamined in the Hong Kong context.     

Teachers' perceptions of integrated kindergarten programs in Hong Kong

This article reports findings from a qualitative interview study that examined the provision of integrated kindergarten education for children with disabilities from the perspectives of general education teachers implementing integrated kindergarten programs. Analysis of interviews with eight informants led to the identification of two broad generalizations: the interviewed teachers emphasized teaching academics to children without disabilities, but they focused on social development at the exclusion of academic instruction for children with disabilities; and, according to the teachers, instruction was academic and skill-oriented in the integrated kindergarten programs. Research procedures are described and data supporting the findings are presented. Ways to improve program quality are discussed in terms of three major components: the Hong Kong government should include early childhood education within the compulsory education system, and enforce the formally recommended approach of developmental appropriateness; teacher education institutions should prepare prospective teachers to work in school settings where program goals may be contradictory with the ideology of inclusion; and educational researchers should monitor program quality in integrated childcare centers by conducting further research.     

Patterns of health care utilization and health behaviors among street sex workers in Hong Kong

OBJECTIVE: To describe the current use of health services by the street-based female sex workers (FSWs) and to explore beliefs behind these health behaviors. STUDY SETTING: Community outreach approach in a few red-light districts in Hong Kong. STUDY DESIGN: A 30 min face-to-face interview was carried out in 89 women by direct approach and snowballing, followed by a focus group discussion drawn from the participants of the questionnaire. RESULTS: While these FSWs' perception of personal health was good, a considerable proportion suffered from illnesses but the consultation rate was a third of the mean rate of the general population in Hong Kong. Many street workers experienced difficulty in utilizing health service in Hong Kong and even when they did, it was mainly for acute problems. Affordable access to health public services was excluded and many found private services unaffordable due to the high price charged by the practitioners. It was common for these women to self-medicate, delay in seeking medical help, or travel back to China for treatment. CONCLUSION: The current empirical understanding of the health and health service utilization by sex workers is unbalanced. In order to reduce sexually transmitted infections (STIs) and HIV among the street sex workers, it is essential to address the fundamental issue of health care access.     

Health care without managed care in Hong Kong

Although managed care may be more effective than fee-for-service in containing health care costs in the United States, it is less effective in countries with a national health service. In Hong Kong, costs have been contained despite the fact that 95% of general practitioners still practice on a solo, fee-for-service basis. The author describes in detail how the system of tax-based hospitals guarantees universal access without escalating costs.     

Business planning in Hong Kong hospitals: the emergence of a seamless health care management process.

This paper examines the progress made by public hospitals in Hong Kong in implementing a business planning approach. A review of available literature suggests two main exploratory themes. The first establishes the key features of business planning in the private sector. The second theme discusses the problems of adapting this approach to the distinctive requirements of the public sector. The literature also suggests three dimensions for evaluating planning: incremental-developmental; reactive-proactive; ends-means. Qualitative data were collected by scrutinizing relevant organizational documentation and by discussions with focus groups formed by participants in the planning process. The data were analyzed against eight key elements of a business plan identified from the literature and from panels of business experts. These elements were found to be present in the Hospital Authority's plans but were less evident in hospital level plans. Because of the unitary nature of hospital organization in Hong Kong, it has been difficult for hospitals to break out of a reactive, incremental and ends-based pattern to a more imaginative identification of the distinctive business and market that they may be in. This is, however, changing rapidly and it is clear that there is in place a robust and 'seamless' health care management process.     

Problems of primary health care in a newly developed society: Reflections on the Hong Kong experience

Hong Kong has emerged as a newly developed society in Asia and its modern scientific health care system has had a substantial expansion. Recently, the rise of medical costs has made the health authority come to stress the development of PHC. This paper focusses on three major aspects of the PHC development in Hong Kong: (1) public health and preventive care; (2) food supply and nutrition; and (3) first-contact medical care and referral network.It is argued that in a newly developed society, the emphasis on developing both the quality and the quantity of PHC in the scientific biomedical stream is justifiable. However, at least two kinds of problems need to be taken into consideration, i.e. the prevalence of traditional beliefs and practices and the ever-rising demands of the public for health services.     

Consumers' health perceptions of three types of milk: a survey in Australia

A survey was conducted among 345 randomly selected shoppers in Melbourne, Australia, to identify their perceptions of the healthiness of whole milk, reduced fat milk and soy milk and to investigate demographic influences on health perceptions and types of milk consumption.The survey revealed major differences in shoppers' perceptions of the three types of milk along the themes of bone health, weight control, disease prevention, and, allergy and disease causation. Generally whole milk was perceived more negatively than soy or reduced fat milk. There were few demographic differences in the shoppers' perceptions of the three products. Reported consumption of reduced fat milk was more frequent among women and elderly people, and whole milk consumption was positively related to parenthood.The findings suggest that previous marketing and education campaigns have been effective but the widespread uncertainty and erroneous beliefs about milk products suggest that many consumers have not assimilated new findings about milk products. This represents a challenge for industry and public health practitioners.     

Health care financing in Hong Kong: a case for tax‐based financing

With the new government of the Hong Kong Special Administrative Region currently conducting a review of Hong Kong's health care financing system, this article argues that the existing tax‐based system not only works well at present, but is also sustainable in the future. The performance of the system is analysed in terms of cost, health outcomes and access. The arguments for change are discussed, and the case for maintaining the status quo is presented. The author concludes that the way forward would be to fine tune the existing system rather than to replace it with other systems which are known to have higher transaction costs and more serious supply‐side moral hazards. Copyright © 1999 John Wiley & Sons, Ltd.     

Hong Kong Chinese perceptions of the experience of unrelated bone marrow donation

This paper presents a qualitative perspective of the Chinese experience of unrelated bone marrow donation. A total population of 37 Chinese men and women, residing in Hong Kong who had donated bone marrow to an unrelated recipient were interviewed and asked their retrospective perceptions and experiences during the process of unrelated bone marrow donation. The majority was female (60%) and single (59.3%). The median age was 30.9 years. The main themes drawn from thematic content analysis included: association with bad and good fortune, religious concerns associated with complete bodies, barriers posed by the extended family, fulfilling personal identities linked to perceptions of altruism, reciprocity and generosity and the differences between the expectations and reality of the experience of bone marrow donation. These accounts indicate how, for Chinese populations, the act of body fluid donation cannot be isolated from the experiences of life-long immersion in the dominant social and cultural processes of the time. In addition, Confucian notions of the body, the power of body fluids to pollute, the importance of blood and bones as sources of vital energy and the process of bodily transference into the after life are highlighted. Furthermore, what is also identifiably Chinese is that donation is more of a self-fulfilling act than a social act with very little familial or social recognition being accorded in the public world. The conclusion highlights how donors entered into the decision to donate with little awareness of the long-term consequences. The process, however, was seen by the donors to be beneficial. A compelling argument is made for more educational and emotional support regarding the experience of bone marrow donation from Hong Kong's formal service providers.     

Community health and reform in Hong Kong

In this paper I argue that the health crisis in the underdeveloped world today is not primarily one of shortages of services, but is a result of lack of power and control over economic, political and social institutions by the majority of the population. Hong Kong is presented as a case study in which a plural medical system is dominated by a political economy that shapes patterns of both sickness and health care. As an advanced capitalist colony, a financial center for the Pacific Basin, and a neutral area for China's foreign negotiations, social policies in Hong Kong aim at promoting business growth, often at the expense of the health of the population. Further, government and voluntary agencies attempts at reforming the health system have done little more than further solidify biomedicine and its social relations. Finally an attempt is made to define potential vehicles for change.