published_or_final_version / Politics and Public Administration / Master / Master of Public Administration

No description available.

University of Macau / Faculty of Social Sciences / Department of Economics

Primary health care (PHC) is an effective way to "optimize and reorganize the health care service system" and solve the "difficulty in obtaining expensive medical services". In the process of China's promotion of health care reform, PHC has been placed at the core part. In this paper, by tracing the history of the development of China's PHC, and evaluating, analyzing and comparing the current similar policies in the field of PHC in China and Britain, a certain understanding of the effects of China's current PHC policies has been presented. In the end, some suggestions inspired by UK experiences been proposed for the future development of PHC in China. Keywords Primary health care; China; health care reform; UK primary health care

published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

published_or_final_version / Public Administration / Master / Master of Public Administration

by Frances Kam Yuet Wong. / Thesis (Ph.D.)--Chinese University of Hong Kong, 1996. / Includes bibliographical references (leaves 276-290). / ACKNOWLEDGEMENTS --- p.i / LIST OF FIGURES --- p.ii / LIST OF TABLES --- p.iii / ABSTRACT --- p.iv / Chapter CHAPTER 1 --- THE RESEARCH PROBLEM AND RELATED LITERATURE / Chapter 1.1 --- The research problem --- p.1 / Chapter 1.2 --- Related literature review --- p.8 / Section I / Chapter 1.2.1 --- Sociology of work --- p.9 / Chapter 1.2.2 --- Sociology of profession --- p.11 / Chapter 1.2.3 --- Change of social structure in a post-industrial society --- p.17 / Chapter 1.2.4 --- A new labouring process and control of work --- p.23 / Section II / Chapter 1.2.5 --- The health care system --- p.26 / Chapter 1.2.6 --- The reconceptualization of nursing --- p.30 / Chapter 1.2.6.1 --- Proletarianization of nursing --- p.30 / Chapter 1.2.6.2 --- Professionalization in nursing --- p.32 / Chapter 1.2.7 --- Nursing education --- p.37 / Chapter 1.2.8 --- The nursing labour process --- p.43 / Chapter CHAPTER 2 --- RESEARCH METHODOLOGY / Chapter 2.1 --- Research methodology --- p.47 / Chapter 2.2 --- Data collection --- p.48 / Chapter 2.2.1 --- Documents --- p.50 / Chapter 2.2.2 --- Interviews --- p.50 / Chapter 2.2.3 --- Participant observation --- p.53 / Chapter 2.3 --- Data analysis --- p.54 / Chapter 2.3.1 --- Extended case method --- p.54 / Chapter 2.3.2 --- Participant observation --- p.56 / Chapter 2.3.3 --- Treatment of data --- p.60 / Chapter CHAPTER 3 --- MICROLEVEL -WORK OF FRONTLINE NURSES / Chapter 3.1 --- Introduction --- p.64 / Chapter 3.2 --- Areas of work of frontline nurses at ward level --- p.70 / Chapter 3.2.1 --- Patient care --- p.70 / Chapter 3.2.2 --- Student supervision --- p.74 / Chapter 3.2.3 --- Staff development --- p.75 / Chapter 3.2.4 --- Ward in-charge --- p.75 / Chapter 3.2.5 --- Ward projects --- p.77 / Chapter 3.2.6 --- Ward resource management --- p.78 / Chapter 3.3 --- Dynamics of work transformation at microlevel nursing practice --- p.78 / Chapter 3.3.1 --- A new division of nursing labour --- p.79 / Chapter 3.3.2 --- The HA policy --- p.84 / Chapter 3.3.3 --- Medical dominance --- p.87 / Chapter 3.3.4 --- Development of the profession of nursing in hospitals --- p.90 / Chapter 3.4 --- Discussion --- p.92 / Chapter 3.4.1 --- The nexus between profession and work --- p.92 / Chapter 3.4.2 --- Professionalization and proletarianization of nursing --- p.94 / Chapter 3.4.3 --- The changing scene of medical dominance --- p.98 / Chapter CHAPTER 4 --- MESOLEVEL - WORK OF NURSES IN MIDDLE MANAGEMENT / Chapter 4.1 --- Introduction --- p.102 / Chapter 4.2 --- Areas of work of nurse managers at mesolevel --- p.107 / Chapter 4.2.1 --- Patient care --- p.107 / Chapter 4.2.2 --- Student supervision --- p.108 / Chapter 4.2.3 --- Staff development --- p.109 / Chapter 4.2.4 --- Operational and resource management --- p.110 / Chapter 4.2.5 --- Communication --- p.112 / Chapter 4.2.6 --- Planning and quality improvement --- p.115 / Chapter 4.3 --- Dynamics involved in the work of nurses at the mesolevel --- p.119 / Chapter 4.3.1 --- A clear establishment of the status of nurse managers --- p.119 / Chapter 4.3.2 --- The nurse as a manager --- p.123 / Chapter 4.3.3 --- The attenuation of medical power by management forces --- p.129 / Chapter 4.3.4 --- Management practice based on negotiation and rationality --- p.134 / Chapter 4.4 --- Discussion --- p.137 / Chapter 4.4.1 --- The Professional-Managerial Class (PMC) --- p.140 / Chapter 4.4.2 --- The emergence of a new class of nurse elite - the nurse managers --- p.143 / Chapter 4.4.2.1 --- Production of nursing care and its reproduction --- p.144 / Chapter 4.4.2.2 --- Control of the means of production --- p.146 / Chapter 4.4.2.3 --- Ideological proletarianization --- p.148 / Chapter 4.4.2.4 --- Negotiation - guanxi and rational-legal authority --- p.149 / Chapter 4.4.2.5 --- The affinity between nursing and management --- p.152 / Chapter CHAPTER 5 --- MESOLEVEL - WORK OF NURSE SPECIALISTS / Chapter 5.1 --- Introduction --- p.156 / Chapter 5.2 --- Areas of work of nurse specialists (NS) at mesolevel --- p.160 / Chapter 5.2.1 --- Client care --- p.160 / Chapter 5.2.2 --- Project work --- p.164 / Chapter 5.2.3 --- Staff development --- p.165 / Chapter 5.2.4 --- Research --- p.166 / Chapter 5.2.5 --- Management and communication --- p.168 / Chapter 5.3 --- Dynamics involved in the work of nurses at this mesolevel --- p.169 / Chapter 5.3.1 --- Removal of NS's accountability from the management hierarchy --- p.170 / Chapter 5.3.2 --- The NS Referral --- p.173 / Chapter 5.3.3 --- The emergence of a new class of nurse elite - the Nurse Specialists --- p.180 / Chapter 5.4 --- Discussion --- p.185 / Chapter 5.4.1 --- Legitimation of the work of the Nurse Specialists in the hospital --- p.185 / Chapter 5.4.2 --- Differentiation of nursing practice - Advanced Nursing Practice --- p.192 / Chapter CHAPTER 6 --- MACROLEVEL - HOSPITAL AUTHORITY AT WORK / Chapter 6.1 --- Introduction --- p.197 / Chapter 6.2 --- The work of the nurse executive in hospital --- p.198 / Chapter 6.2.1 --- Human resource management and staff development --- p.202 / Chapter 6.2.2 --- Management of departments and hospitals --- p.203 / Chapter 6.2.3 --- Quality improvement --- p.205 / Chapter 6.2.4 --- Research and professional development --- p.207 / Chapter 6.2.5 --- Communication --- p.209 / Chapter 6.3 --- The direction of nursing work at the level of hospital authority --- p.210 / Chapter 6.3.1 --- Overall nursing direction and development --- p.213 / Chapter 6.3.2 --- Nursing role delineation and work redesign --- p.215 / Chapter 6.3.3 --- Recruitment and retention of Nurses --- p.223 / Chapter 6.3.4 --- New direction for nursing education --- p.225 / Chapter 6.4 --- Discussion --- p.228 / Chapter 6.4.1 --- Corporatization of health care system in Hong Kong --- p.229 / Chapter 6.4.2 --- The control of nursing labour process --- p.233 / Chapter 6.4.3 --- Regulation of nursing through education --- p.237 / Chapter CHAPTER 7 --- CONCLUSION AND DISCUSSION / Chapter 7.1 --- Introduction --- p.249 / Chapter 7.2 --- The nexus of profession and work --- p.250 / Chapter 7.3 --- Charting a pathway for nursing towards the twenty-first century --- p.258 / Chapter 7.4 --- A micro-meso-macro approach of social analysis --- p.269 / Chapter 7.5 --- Practical implications of the study --- p.271 / Chapter 7.6 --- Limitations of the study --- p.273 / REFERENCES --- p.276 / APPENDICES / Chapter 1 --- Abbreviations --- p.291 / Chapter 2 --- Interview guide --- p.292 / Chapter 3 --- A sample of appointment specification of HCA --- p.293 / Chapter 4 --- A sample of appointment specification of RN --- p.294 / Chapter 5 --- A sample of appointment specification of NO --- p.295 / Chapter 6 --- A sample of appointment specification of NS --- p.296 / Chapter 7 --- A sample of appointment specification of WM --- p.297 / Chapter 8 --- A sample of appointment specification of DOM --- p.298 / Chapter 9 --- A sample of appointment specification of GMN --- p.299 / Chapter 10 --- Nursing strategies: Towards the year2000 --- p.300

Background: As in the rest of the world, cancer has been a leading killer in Hong Kong. Though technology has been growing rapidly, expensive cancer treatments have continuously been problematic to patients and their families. There are some known risk factors that make some people have a higher risk for cancer than others, but the reason why some develop cancer and some do not is mostly still unknown. In addition, the expensive cancer treatments can distress patients and their families psychologically during the painful and long chemotherapy process which is a common cancer treatment. While it is important for experts to research on effective cancer treatment, it is also important for the government and health care experts to solve associated financial problems. In response to help patients to ease their financial burden of expensive medical treatment, the Hong Kong government has proposed a new health protection scheme (HPS), “My Health, My Choice.” Objective: In this paper, a systematic review on different published literatures is conducted to analyze the prospective outcome of HPS and if it can help patients to ease their financial burden. Results and Discussion: The Health scheme provides a financial aid option for patients who suffer from chemotherapy through monthly premium. However, the implementation of this HPS seems to be difficult both on the patients’ and the providers’ sides. Case study of health care systems in US and Canada is included in this paper to find out what Hong Kong can learn from other countries with completely different payment systems would manage to deal with this problem. Australia which with a universal coverage health care system has also proposed a similar HPS plan aiming to help lower health care cost by increasing individual responsibility on medical expenses. However, it failed by lack of support from the general public. The Australian example would be used to criticize some essential elements that would contribute to the failure of the HPS, and how Hong Kong would use this example to yield a better proposal. Conclusion: As HPS might not be able to ease the burden on cancer patients in Hong Kong, it is suggested for government to allocate more effective and direct resources on helping cancer patients, especially those who are receiving chemotherapy or improve services through better primary care. However, the final outcome remains unknown, and the final option still depends on the ultimate need from the general public. / published_or_final_version / Public Health / Master / Master of Public Health

University of Macau / Faculty of Social Sciences / Department of Government and Public Administration

殖民時期的香港一直被丛书新自由主義的經典例子。加上香港殖民政府的剝削本質，它一般不會提供廉價醫療服務給予普羅大眾。然而，儘管有「積極不干預主義」這口號，殖民政府仍然於香港留下了龐大公營醫療系統。為什麼龐大公營醫療系統與放任自由主義並存於二次世界大戰後的香港社會？ / 為了解答以上疑問，本研究將從一九六四年醫療改革，探討香港戰後醫療政策。本文認為，香港研究忽視了冷戰對香港公共衛生的影響。文獻回顧後，實證研究分為三部分。第一部分提出「衛生關注」(Sanitary Concern)不足以構成醫療改革的原因。第二部分通過文本分析，發現六十年代的主流報章不重視醫療改革，由此可見改革並非基於公眾的訴求。最後的部分從戰後政府檔案，發現長遠的公營醫療規劃沿於五十年代後期。同時，戰後公營醫療系統的擴張，更可能是因為殖民政府為了確保足夠的戰時緊急醫療服務，及防止左派利用社區診所滲透入基層。 / Hong Kong has been regarded as a textbook example of Neo Liberalism. The exploitative nature of a colonial government makes it unlikely for the colonial state to make commitment for low-cost medical services to the general public. However, the slogan of “positive non-interventionism notwithstanding, the strong public health sector in Hong Kong is also a colonial legacy. Why was such a state-centered medical system established in a laissez-faire society after the Second World War? / This thesis aims at investigating the 1964 hospital reform in Hong Kong to study the colonial governance and arguing that the Cold War factor has been neglected in the analysis of the medical-institutional change. After the literature review, there are three empirical sections to support this explanation. The first part finds that sanitary concern was not a strong reason for the reform. In the second part, a context analysis on newspaper during the 1960s shows that the hospital reform was simply neglected by most newspapers, which implies that the reform was not the direct result of public pressure. The final part looks into the long-term medical planning since the late 1950 and several related medical policies through different archives in order to demonstrate the impacts of Cold War’s politics on Hong Kong’s medical services provision. Evidences suggest that self-sufficiency of military-emergency medical services and control over the growing influence of left-wing community clinics could be a more convincing explanation for the reform. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Tang, Kai Yi. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 156-165). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in Chinese. / Thesis/Assessment Committee --- p.i / Abstract --- p.ii / Acknowledgments --- p.iv / List of tables, graphs and figures --- p.v / Acknowledgments --- p.vii / Chapter Chapter One --- Introduction --- p.1 / Chapter 1.1 --- The 1964 medical white paper: the first commitment in the colonial history --- p.2 / Chapter 1.2 --- A state-centred medical system as a colonial legacy --- p.6 / Chapter 1.3 --- The research question --- p.8 / Chapter 1.4 --- Methodology --- p.10 / Chapter 1.5 --- The central argument and outline of the thesis --- p.12 / Chapter Chapter Two --- Literature Review --- p.14 / Chapter 2.1. --- Politics of health in Hong Kong: a sudden change from the voluntary sector to the state? --- p.14 / Chapter 2.2 --- The origin of public health in Britain, India and Singapore --- p.17 / Chapter 2.3 --- Inadequate explanations for the 1964 hospital reform --- p.19 / Chapter 2.4 --- The nature of the Colonial governance: laissez-faire or Interventionist? --- p.21 / Chapter 2.5 --- British Hong Kong: Lacking commitments to local community --- p.24 / Chapter 2.6 --- The partial vision of public health in the colony --- p.25 / Chapter 2.7 --- Financial conservatism, the Pound crisis and social reforms in Hong Kong --- p.29 / Chapter 2.8 --- “1967 riot“ and “MacLehose“ as a explanation for the post-War social reforms --- p.33 / Chapter 2.9 --- An alternative: Cold War, the colonial governance and social service provision --- p.37 / Chapter Chapter Three --- Sanitary concern, diseases and state interventions in Hong Kong: Did the epidemic matter again? --- p.44 / Chapter 3.1 --- The origin of sanitary concern in Victorian Britain --- p.44 / Chapter 3.2 --- Impacts and limitations of sanitary concern in Hong Kong --- p.48 / Chapter 3.3 --- The 1894 Plague as a turning point: the first expansion in the colonial medical system --- p.50 / Chapter 3.4 --- Shadow of sanitary concern after the War --- p.53 / Chapter 3.5 --- Health profile in Hong Kong: a gradual improvement? --- p.56 / Chapter 3.6 --- A epidemiological transition in infectious diseases since 1945 --- p.59 / Chapter 3.7 --- Conclusion: Did diseases really matter? --- p.64 / Chapter Chapter Four --- Public opinion on public health: a driving force to the reform? --- p.65 / Chapter 4.1. --- The political culture in post-war Hong Kong --- p.66 / Chapter 4.2 --- From the rise in telephone fees to a social event in newspapers --- p.69 / Chapter 4.3 --- A content analysis on newspapers in 1964 --- p.72 / Chapter 4.4 --- Most medical news: informative but not critical --- p.73 / Chapter 4.5 --- Hospital reform: simply ignored? --- p.77 / Chapter 4.6 --- Reform: a result of public pressure? --- p.81 / Chapter 4.7 --- A social event: “charity clinics problem“? --- p.84 / Chapter 4.8 --- Conclusion: an ignored reform by an active Chinese community? --- p.88 / Chapter Chapter Five --- Politics of public health in post-war Hong Kong: clinics, hospitals and the Cold War --- p.89 / Chapter 5.1 --- British in Cold War: to defend a valuable but vulnerable port --- p.90 / Chapter 5.2 --- Coincidence: A growing government medical sector since 1957 --- p.97 / Chapter 5.3 --- Planning since 1957: reserved lands, standard clinic design and Executive Council --- p.108 / Chapter 5.4 --- Planning in New Territories: a Heung Yee Kuk’s petition for a new hospital --- p.113 / Chapter 5.5 --- A forgotten alternative in medical financing: medical insurance schemes --- p.117 / Chapter 5.6 --- Politics between Hong Kong and London: Mayo Clinic --- p.120 / Chapter 5.7 --- Incinerators and generators: the role of civil hospitals in defence --- p.123 / Chapter 5.8 --- Civil hospitals in M.D.S.: to defend the indefensible Colony --- p.124 / Chapter 5.9 --- “Inconsistent planning: to defend Hong Kong without military hospitals? --- p.135 / Chapter 5.10 --- Threats from the communist: regulations on refugee doctors and charity clinics --- p.138 / Chapter 5.11 --- Conclusion: 1964, a year of no significance? --- p.144 / Chapter Chapter Six --- Conclusion --- p.145 / Chapter 6.1 --- Summary of arguments --- p.145 / Chapter 6.2 --- A reference point: Cold War’s politics and the medical reform in Singapore --- p.148 / Chapter 6.3 --- Implications on public health and Hong Kong studies --- p.152 / Chapter 6.4 --- Limitations and directions of further study --- p.153 / Reference --- p.156