published_or_final_version / Dentistry / Master / Master of Dental Surgery

published_or_final_version / abstract / Community Medicine / Master / Master of Public Health

published_or_final_version / Housing Management / Master / Master of Housing Management

This dissertation seeks to understand the relationships between the evolving political economies and modes of public health governance in Hong Kong, Singapore and Taiwan from the 19th century to nowadays. It is argued that from a political economy perspective, a suitable institutional set-up is important in providing political resources necessary for the evolution of public health governance. This dissertation looks specifically at political resources that include authority, legitimacy, finance and knowledge. The uneven distribution of these political resources across the polity determines the power gradient amongst different actors. Institutional set-up is also important because it governs the interaction between different actors who are in various ways dependent upon one another. From the 19th century, the polity of these three jurisdictions experienced drastic change under the banner of colonialism. The colonial governments were preoccupied with advancement of colonial interest. With the unrest in the polity, the colonial governments realised the importance of authority and knowledge in perpetuating their existence. At the same time however, the ignorance towards cultural affinity of colonial subject deprived the governments of their ability to regulate the life of the latter. The contradiction was strongly reflected in the two British colonies where there were clashes over the application of public health law and regulation. Japan, by contrast, was more able to garner authority because of her tactics to couple traditional control with modern policing. In the post-war era, the political economy of these three jurisdictions departed from one another. In Hong Kong, the colonial set-up shifts from regulatory-led to developmental-led institutional set-up. Similar tendency can be observed in Singapore and continued after her independence. Bureaucratic authority became the most available resources for government to mobilise. In strong possession of authority and finance, the government was increasingly able to introduce expansionary measures. This is accompanied by the rise of rational planning in Hong Kong and Singapore. As a result, there witnessed bureaucratisation of public health governance which shaped the dependent interactions between the authorities and citizen and the sporadic contribution from charities and overseas organisations. Taiwan departed significantly from these two jurisdictions. The inception of Kuomintang’s authoritarian regime attempted to continue the regulatory-led institutional set-up from the colonial regime in the 1950s. Whilst authority became abundant, financial resources were drained away to military project. International agents became the key actor to contribute to the functioning of public health governance. In the 1970s to 1990s, the fiscal crisis arising from exponential increase of public expenditure and the international policy discourse of deregulation led to the declining ability of tax-based direct provision of health care. There displayed a greater willingness to rely on more actors and more instruments to divest the responsibility of the government. However the negligence about the potential trade-off between authority and finance limited the dynamics of coordination between different actors. The sudden outbreak of the SARS episode in 2003 unveiled the problem of underinstitutionalisation of polity. It unsettled the role of power and authority of government as demonstrated in Singapore and unleashed the latent power of civil society in the arena of public health as seen in Hong Kong and Taiwan. It also illuminated the role of knowledge in dealing with uncertainty in an institutional set-up. / published_or_final_version / Urban Planning and Design / Doctoral / Doctor of Philosophy

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

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

Thesis (D.P.H.)--University of Hawaii at Manoa, 1996. / Includes bibliographical references (leaves 150-163). / Microfiche. / xiv, 163 leaves, bound ill. 29 cm

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

University of Macau / Faculty of Social Sciences and Humanities / Department of Communication