published_or_final_version / abstract / Journalism and Media Studies Centre / Master / Master of Philosophy

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

published_or_final_version / Dentistry / Master / Master of Dental Surgery

Introduction Self-rated health (SRH) is a widely used indicator of health service utilisation and reflects self-perceived objective health condition. Poorer non-comparative SRH was shown to be related to higher inpatient and outpatient utilisation in Western and elderly populations. Little is known about how healthcare utilisation relates to SRH in non-Western settings, such as Hong Kong and in adult populations. The association of age- and time- comparative SRH with healthcare utilisation is also unclear. This study aimed to assess the association of three types of SRH (non-, age- and time- comparative SRH) with inpatient and outpatient utilisation in Hong Kong‟s general populaion. Methods Data were derived from 2011 Thematic Household Survey (THS), covering 23,892 non-institutional residents aged 20 and above. The study adopts Andersen‟s Behavioral Model of Health Service Use for the analytical framework. Healthcare utilisation was measured by inpatient use during the past year and outpatient use (including General Outpatient Clinic (GOPC) and Specialist Outpatient Clinic (SOPC)) during the past month, in terms of ever-use and the amount of use (bed-days and number of outpatient visits). SRH was measured with a 5-point Likert Scale: non-comparative SRH from “Excellent” to “Poor”; age- and time- comparative from “much worse” to “much better”. Logistic regression and zero-truncated negative binomial/ Poisson regression were applied to examine the association of SRH and chronic diseases with healthcare utilisation in the public and private sector separately as per the Andersen behavioral model. Results “Fair/ poor” non-comparative SRH was associated with higher inpatient and outpatient utilisation. The association was not significant for hospital bed-days. Similarly, age-comparative SRH was associated with inpatient (except private bed-days) and outpatient utilisation (except the number of SOPC visits). “Worse/ much worse” time-comparative SRH was associated with higher healthcare utilisation, but the relationship was less clear for private hospitalisation. The presence of cancer, cardiovascular diseases, diabetes, lower respiratory diseases, and musculoskeletal diseases were associated with higher healthcare utilisation, with stronger association observed for ever-use than the amount of use. The relationships between musculoskeletal diseases and inpatient utilisation, between cardiovascular diseases and diabetes and the number of private outpatient visits, and between lower respiratory diseases and GOPC utillisation were not significant. Conclusions The present study suggests SRH to be a useful health indicator of health service utilisation. All three SRH measures were associated with health service utilisation and no marked differences were observed between different measures. Poorer SRH were strongly related to higher public inpatient utilisation, with stronger association observed for ever hospitalisation than bed-days. Poorer SRH measures were also related to higher outpatient uilisation in both sectors during the past month. All the selected chronic conditions were related to increased healthcare use. The associations were less clear for hospital bed-days and the private sector. Future studies should focus on the predictive validity of SRH on future healthcare utilisation. / published_or_final_version / Public Health / Master / Master of Philosophy

published_or_final_version / Dentistry / Master / Master of Dental Surgery

我們身處於一個充滿風險的社會。金融海嘯、核能危機、全球暖化、食品問題等，在說明社會步向現代化的後遺症，正如何為人類帶來更難預測的風險，並無孔不入般影響我們的日常生活(Beck, 1992)。在這理論基礎上，本文將探究新聞製作於建構風險的角色，並提出一個名為「客觀化」(objectification) 的過程---新聞媒體如何在科學專家的意見眾說紛紜、對風險難有最終定案之下，把有關社會風險的新聞論述詮釋為客觀的社會事實。我尤其探討風險範例的建構---一些有關風險的新聞事件其後演變為重要範例，並影響日後類似事件的新聞論述。 / 為求以實證方法探究風險「合理化」的過程，我將以香港(中華人民共和國的特別行政區) 的新聞論述如何回應2009年全球豬流感危機作為案例。豬流感是香港經歷2003年非典型肺炎危機(又稱「沙士」) 的重創後，首次面對的全球疫症危機。香港新聞如何呈現豬流感疫情，亦深受「沙士」時的歷史回憶、經驗及後遺所影響。故此，這案例有助我研究風險範例於風險「合理化」時的作用。我從香港報章隨機抽樣出有關豬流感的新聞論述的樣本，並透過內容分析和文本分析，研究香港新聞如何敍述豬流感危機，以及相關敍述所包含的意識形態。我亦走訪了當年採訪豬流感新聞的新聞工作者、有份向傳媒提供專家意見的醫學專家、以及負責制定香港政府防控豬流感政策的官員，以了解建構豬流感風險背後的社會互動。 / 本文的研究顯示，香港有關豬流感危機的新聞論述，是如何奠基於「沙士」這風險範例而建構。豬流感起來襲初時，新聞論述廣泛地藉「沙士」的經驗去詮釋豬流感可能帶給香港的後果。新聞工作者於「沙士」時的採訪經歷，亦成為他們報道豬流感新聞時尋找醫學專家意見的參照經驗，尤其是當醫學專家意見紛紜、新聞工作者要判斷誰人的意見較有權威去界定健康風險之時。本文主要闡述新聞的建構於社會回應風險時所起的關鍵作用，從而帶出這於風險社會理論、以及當我們探究新聞媒體及傳播於現代風險社會的角色時，仍未受足夠重視的重要層面。 / We are witnessing the formation of a risk society, with financial instability, nuclear catastrophes, global warming, and food crises, and just to give a few examples, becoming parts of our everyday life in an age of risk characterized by uncertainties stemming from system failure of modernization (Beck, 1992). In the light of this theoretical concern, in this study I shall scrutinize how news making plays its role in the construction of risk. This, I suggest, is a process of risk objectification ---how news media justifies its discourse of social risk by making social facts upon uncertainties and inconclusive scientific opinions. Specifically, I shall focus on the creation of risk exemplar. That is, some news events become critical exemplar that would shape the news construction of subsequent crises of similar sources. / To look into the process of risk objectification empirically, I shall examine what were the main features of the news discourse in Hong Kong, a Special Administrative Region of China, in reaction to the global health crisis of Swine Flu in 2009. Swine Flu was the first pandemic crisis encountered by Hong Kong after its devastating suffering from the epidemic of Severe Acute Respiratory Syndrome (SARS) in 2003. The news representation of Swine Flu was influenced by the historical memory, experience and legacies of SARS and this helps illustrate how risk exemplar contributes to risk legitimization. I carried out content and textual analysis respectively on a random sample of Hong Kong’s newspapers for the purpose of analyzing the key narrations of Swine Flu and the underlying ideological packages of such narrations. I also conducted in-depth interviews with journalists, medical experts and public officials who were deeply involved in the news making of Swine Flu so as to uncover the social dynamics in the process of risk construction. / Key findings of this thesis highlight how the health crisis of Swine Flu was staged by the risk exemplar of SARS. Experience of SARS was widely drawn upon for making sense of the potential impacts of Swine Flu when it first broke out. It was also the key reference for journalists when seeking expert advices, particularly when identifying those who are more authoritative among different opinions in defining the nature of the risk. It is my argument that news making plays a critical role in the shaping of the social reactions to a risk. My analysis thus adds an important, but somehow unduly neglected, dimension to theory of risk society and our understanding of the role of news media and communication in contemporary risk society. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Chan, Chi Kit. / Thesis (Ph.D.) Chinese University of Hong Kong, 2014. / Includes bibliographical references (leaves 240-250). / Abstracts also in Chinese. / Chan, Chi Kit.

Wong, King Moses. / "August 2010." / Thesis (M.Phil.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 158-172). / Abstracts in English and Chinese. / Chapter Chapter One: --- Introduction --- p.1 / Chapter 1.1 --- Background --- p.1 / Chapter 1.2 --- Research objectives --- p.5 / Chapter 1.3 --- Research hypothesis --- p.7 / Chapter 1.4 --- Research questions --- p.7 / Chapter 1.5 --- Research structure --- p.9 / Chapter Chapter Two: --- Literature Review --- p.10 / Chapter 2.1 --- "Health geography: knowledge of population, people, places and health" --- p.10 / Chapter 2.2 --- Understanding geographies of diseases: mapping and modeling diseases and health --- p.17 / Chapter 2.3 --- Healthcare services provision and utilization --- p.22 / Chapter 2.4 --- Hong Kong: facts and context --- p.31 / Chapter 2.4.1 --- Demographics --- p.32 / Chapter 2.4.2 --- Key challenges arising from population ageing --- p.37 / Chapter 2.4.2.1 --- Implications to medico-social agenda --- p.38 / Chapter 2.4.2.2 --- Implications to health status --- p.38 / Chapter 2.4.2.3 --- Implications to disease pattern --- p.39 / Chapter 2.4.3 --- Healthcare service delivery system in Hong Kong --- p.41 / Chapter 2.4.3.1 --- Financing and expenditure --- p.42 / Chapter 2.4.3.2 --- Organizational framework and healthcare policy --- p.44 / Chapter 2.4.3.3 --- Healthcare resources --- p.49 / Chapter 2.4.3.4 --- Utilization and provision of public healthcare services --- p.50 / Chapter Chapter Three: --- Material & Methods --- p.55 / Chapter 3.1 --- Background of main source of data --- p.55 / Chapter 3.2 --- Sources of data --- p.57 / Chapter 3.2.1 --- Hospital services utilization data --- p.57 / Chapter 3.2.2 --- Healthcare resources data --- p.61 / Chapter 3.2.3 --- Population data --- p.62 / Chapter 3.3 --- Spatial scale of analysis --- p.62 / Chapter 3.4 --- Statistical analyses --- p.63 / Chapter 3.4.1 --- Service utilization ratios --- p.63 / Chapter 3.4.2 --- Provision of healthcare resources to population --- p.65 / Chapter 3.4.3 --- Adequacy of healthcare services provision --- p.65 / Chapter 3.4.4 --- Mortality analysis --- p.67 / Chapter 3.4.5 --- Multi-level analysis --- p.69 / Chapter 3.4.6 --- Mapping of health services utilization ratio and mortality ratio --- p.70 / Chapter 3.5 --- Statistical packages used --- p.73 / Chapter 3.6 --- Cautions on interpretation --- p.74 / Chapter 3.6.1 --- Confounding and ecological fallacy --- p.74 / Chapter 3.6.2 --- Problem with the use of Standardized Mortality Ratio --- p.75 / Chapter 3.6.3 --- Problem with mapping and visualization --- p.76 / Chapter Chapter Four: --- Results --- p.78 / Chapter 4.1 --- Socio-spatial variation in mortality --- p.78 / Chapter 4.2 --- Statistical analysis and mapping of health services utilization ratio --- p.80 / Chapter 4.3 --- Statistical and cartographic analysis in Standardized Mortality Ratio --- p.88 / Chapter 4.4 --- Provision of healthcare resources to population --- p.91 / Chapter 4.5 --- "Multi-level analysis of hospital services utilization, provision and mortality" --- p.92 / Chapter 4.6 --- Further analysis --- p.95 / Chapter Chapter Five: --- Discussion --- p.100 / Chapter 5.1 --- Geographic variations in health services utilization ratios --- p.101 / Chapter 5.2 --- Geographic variation in Standardized Mortality Ratio --- p.107 / Chapter 5.3 --- "Multi-level models on health services utilization, provision and mortality" --- p.121 / Chapter 5.3.1 --- Socio-demographic characteristics of health services utilization --- p.121 / Chapter 5.3.1.1 --- Age --- p.121 / Chapter 5.3.1.2 --- Gender --- p.124 / Chapter 5.3.2 --- Health services utilization in relation to services provision --- p.129 / Chapter 5.3.3 --- Health services utilization in relation to mortality --- p.132 / Chapter 5.3.4 --- Adequacy of healthcare services provision --- p.134 / Chapter 5.3.4.1 --- Adequacy of hospital care provision --- p.134 / Chapter 5.3.4.2 --- Adequacy of primary care provision --- p.139 / Chapter 5.4 --- Implications --- p.143 / Chapter 5.5 --- Strengths of study --- p.146 / Chapter 5.6 --- Limitations of study --- p.148 / Chapter 5.7 --- Recommendations for future research --- p.151 / Chapter Chapter Six: --- Conclusion --- p.154 / References --- p.158