Peter P. Yuen

Rationing hospital services in Hong Kong: priority setting by clinicians using the Delphi method.

This article presents the results of a demonstration project of priority setting by clinicians in Hong Kongs public hospitals. Thirty-five chiefs-of-service of public hospitals in Hong Kong participated in a three-round Delphi exercise on identifying interventions that should be charged in public hospitals on the basis of questionable effectiveness and other reasons. A total of 246 interventions were identified in the first round, 126 of which received a positive score (indicating a high degree of consensus amongst the participants) at the end of the final round. The interventions that received higher scores tend to be preventive services, treatment of an elective nature, and procedures for sex-related conditions. As the number of interventions with positive scores in the final round are relatively small, the amount of money to be recovered from charging these interventions is not likely to be substantial. Such results suggest that rationing by itself cannot be a solution to the problems of healthcare financing in Hong Kong.

Reforming health care financing in urban China

This article examines the structure and problems of financing health care in the urban areas in China in light of the recent market-oriented reforms. It highlights the characteristics and major weaknesses of the existing financing and delivery systems, and examines a number of reform options and their effects on the various stakeholders of the health care system in terms of cost, quality and equity. Preliminary reports on the performance of the new systems are cited. The author recommends (1) the development of a tripartite contributory health insurance system for the better-off enterprises, (2) major changes within the existing Public Health Insurance Scheme, which will remain to cover the newly established civil service, (3) the temporary retention of the Labour Insurance Medical Care Scheme to cover the workers in ailing state corporations, and (4) the promotion of voluntary organizations to provide services to the indigence. He predicts that current reform efforts would not be effective in containing ...

Perceived Discrimination in the Context of High and Low Interactions – Evidence from Medical and General Tourists

This study explored the antecedents and consequences of perceived discrimination of tourists. Both general and medical tourists, who represent contexts of low and high interaction with service providers, respectively, were interviewed in-depth regarding their travel experiences in Hong Kong. The critical incidence approach was applied to identify unfair treatment and other relevant factors. Similarities and differences were found between the discriminatory experiences and antecedents of medical tourists and general tourists. The findings indicate that some unfair treatments were subsequently attributed to discrimination; because of their unique travel motivations, medical tourists more easily attributed unfair treatment to discrimination. Moreover, four groups of factors were identified as antecedents to perceived discrimination: cultural, employee, tourist and situational factors. The results suggest that the relationship between perceived discrimination and post-visit behavioral intentions is moderated by the perceived value of the trip. The practical implications of our findings are discussed.

THE IMPLICATIONS OF THE CORPORATIZATION OF HEALTH CARE DELIVERY IN HONG KONG

IntroductionThe Hong Kong Hospital Authority has been formally established with theenactment of the Hospital Authority Ordinance on July 25, 1990. Thisstatutory corporation will soon take over the management and control of allpublic hospitals, which house approximately 90 per cent of the territoryshospital beds. Government hospitals have hitherto been managed andfinanced directly by a government department - the Hospital ServicesDepartment (previously called the Medical & Health Department). Sub-vented hospitals have in theory been owned by voluntary organizations, butin practice they have been heavily subsidized and tightly controlled by thegovernment. While many have expressed concern over the transfer arrange-ments for staff,

The Corporatisation of Public Hospital Services in Hong Kong: A Possible Public Choice Explanation

This article examines the official explanation for the establishment of the Hospital Authority. It questions the altruistic motives of the government and points out that the reforms recently undertaken in the area of public hospital services could have been carried out at a much lower cost without corporatisation. It analyses the motives of the various key actors in the formation of the Hospital Authority using the public choice approach. Based on available evidence, it concludes that the corporatisation policy was the result of cooperation among proximate policy-makers motivated mainly by self-interest.

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 Kongs 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.

A cost-effectiveness analysis of teledietetics in short-, intermediate-, and long-term weight reduction

Introduction To evaluate the effectiveness of teledietetics in weight loss for 24 weeks and the cost-effectiveness of weight loss between face-to-face and teledietetics services. Methods The study was conducted at a community health center and a community dietetics clinic. The study was a quasiexperimental design. Fifty adults aged 20–50 with a BMI ≥23 participated in the study. The face-to-face (FD) group received 12 dietary counselling sessions and recorded their diet in a log book. The teledietetics (TD) group attended three group nutrition seminars and recorded their diet on a Web-based platform. Changes in variables were compared using an independent t-test. Direct and indirect costs were applied to compute cost-effectiveness ratios. Results At week 6, the FD group showed greater reductions in all variables than did the TD group. At week 12, the effects reversed. At week 24, the accumulated reductions in weight and fat in the TD group were significantly higher than those in the FD group (all at p < 0.0001). The observed direct costs for 1% weight loss and 1% fat loss were USD 28.24 and USD17.09, respectively. Discussion A dietetic service delivered as a teledietetics model is more cost-effective than the face-to-face dietetics model in weight reduction.

Managed care systems in the people's republic of china

This article attempts to determine whether or not managed care is the way forward for health services systems reforms in urban China. It first highlights the problems of the present Chinese urban health care financing system, which is largely based on third party fee-for-service reimbursement. It then analyses the salient features of three existing managed care systems in China -private plans, plans under the existing public and labor medical insurance systems, and the newly introduced pilot Employees Medical Insurance Scheme. Available evidence tend to suggest that all of them have been quite effective in controlling cost escalation, and that there have been some improvement in terms of equity under the new Employees Medical Insurance Scheme.

Sustainable Health and Long-Term Care Solutions for an Aging Population

Sustainable Health and Long-Term Care Solutions for an Aging Population is a pivotal reference source featuring the latest scholarly research on issues pertinent to health cost and nding effective ways of nancing healthcare for the elderly. Including coverage on a number of topics such as provider accreditation, corporate social responsibility, and data management, this book is ideally designed for policy makers, academicians, researchers, and advanced-level students seeking current research on the innovative planning and development of healthcare.

Performance Measurement and Optimization of Resource Allocation in a Health Care System

While cost control has been a significant concern in public health care, stakeholders increasingly strive for a more balanced approach in assessing performance delivered by the health care service providers. This movement has been driven by health care organizations in the developed nations over the past two decades. For instance, in reviewing performance measurement and management in public health services of UK and Sweden, Ballentine et al. (1998) studied their performance measurement systems under a period of reform for market-based competition and discussed the challenges to striking the balance between cost control in the back office and delivery of quality service at the front. Moreover, Radnor and Lovell (2003) unveiled cases of balanced scorecard implementation in NHS of the UK that provided significant benefits for meeting national targets for better transparency, clarity and accountability for the stakeholders, including the patients and public in general. Their study suggests an effective use of a performance measurement system to enable focus on measuring long-term qualitative targets whereas the traditional financial reporting system could be biased towards short-term measures.