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State Capacity and Political Disconnection in the HKSAR: The Case Study of Healthcare Financing Reform

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Hong Kong 20 Years after the Handover

Part of the book series: Studies in the Political Economy of Public Policy ((PEPP))

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Abstract

Ever since 1993 when the consultation document “Towards Better Health” was published, the Hong Kong government has been concerned with the issue of healthcare financing. More than 20 years have passed, and various options have been proposed (Luk 2014; Ramesh 2012; Bauhinia Foundation Research Centre 2007; Gauld and Gould 2002: 119–139), including the latest option of implementing voluntary health insurance, and the prospect of healthcare financing reform is ominous.1Rarely has an outstanding issue in a particularly policy area been dragged on for so long and the failure of a reform effort been so protracted.

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Notes

  1. 1.

    Secretary for Food and Health Dr. Ko Wing-man had already expressed his view that the legislation procedures concerning the implementation of the Voluntary Health Insurance Scheme may not be completed by the present government. See “Reform of Hong Kong medical insurance ‘unlikely to happen during chief executive’s term’,” South China Morning Post, 9 November 2015.

  2. 2.

    Healthcare financing reform is a part of healthcare reform. After the government introduced the idea of voluntary health insurance in 2010, it began to review the regulation of private healthcare facilities, and healthcare manpower planning and professional development in 2012. Clearly, the government does not take healthcare financing as a standalone issue. Increasingly, healthcare financing reform is incorporated by the government into a broader framework of healthcare reform. So, in the rest of this chapter, I shall talk about healthcare reform, which includes healthcare financing reform.

  3. 3.

    My study is about the connection between the government and important stakeholders in the healthcare sector. In the social science literature, connections have been described as network or social capital, and various conceptual implications have been explored. For my own purpose, and in order not to entangle my analysis with the discussion of these implications, I shall make clear that the object of my study as connection.

  4. 4.

    Take the Japanese state, for example. While Johnson (1982) described the Japanese state as strong state, Khosla (2000) described it as weak.

  5. 5.

    Skocpol defines state capacity as “the ability of the state to implement official goals, especially over the actual or potential opposition of powerful social groups” (1985: 9). As I shall argue in the latter part of this chapter, I have a reservation about this definition and its implicit zero-sum view of power. I argue that state capacity is not necessarily the ability to go against the opposition of social groups.

  6. 6.

    Besides HKMA, there are the Hong Kong Doctors Union (HKDU) representing private doctors, Hong Kong Public Doctors’ Association (HKPDA) representing public doctors, the Association of Private Medical Specialists of Hong Kong representing specialists and the Association of Licentiates of Medical Council of Hong Kong (ALMCHK) representing doctors who registered for medical practice after passing the licentiate examination.

  7. 7.

    A typical example of such dependence of the government is the implementation of packaged pricing as one of the most important elements of the Voluntary Health Insurance Scheme proposed by the Hong Kong SAR Government in 2014.

  8. 8.

    The only exception is Kwok Ka-ki, who was a board member of both HKMA and HA between 2004 and 2007 when he was also serving as the representative of the medical profession in the Legislative Council during the same period.

  9. 9.

    Rapport will be enough to produce the expectation, but goodwill will be even more effective in producing the expectation.

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  1. School of Professional Education and Executive Development, The Hong Kong Polytechnic University, Hong Kong, China

    Alex Wo-shun Chan

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  1. The Academy of Hong Kong Studies, The Education University of Hong Kong, Tai Po, Hong Kong

    Brian C.H. Fong

  2. The Academy of Hong Kong Studies, The Education University of Hong Kong, Tai Po, Hong Kong

    Tai-Lok Lui

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Chan, A.Ws. (2018). State Capacity and Political Disconnection in the HKSAR: The Case Study of Healthcare Financing Reform. In: Fong, B., Lui, TL. (eds) Hong Kong 20 Years after the Handover. Studies in the Political Economy of Public Policy. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-51373-7_5

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