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Similar payment card format was used to elicit subsidy and co-pay values Appendix A. Different payment scales were used for different services Appendix B. Ethical approval for the study was obtained from the ethics committees in the Hong Kong Hospital Authority and the DH. All respondents of the WTP survey who had given consent and left contact information to be approached were invited to join the discussions.

A discussion guide was developed in light of the results of the WTP survey and to gauge views on future development of the elderly health care voucher scheme. The discussions in general followed the guide, but participants were also encouraged to freely express their views. The discussions were audio-taped and transcripts were then prepared for analysis. To analyse the WTP survey, we first ran univariate analysis on the respondents to assess sample distribution and characteristics.

Cross-tabulations of WTP with key independent variables such as demographics, enumeration sites and usual source of care were used to examine their relationships. The analysis of variance was used to test whether the means of WTP among the groups are equal. Multivariate analysis was used to further determine the validity of elicited WTP. To address the potential selection bias, we estimated a two-step model Heckman Transcripts of the focus group discussions were analysed, through which recurring themes were identified using NVivo software.

Groups of related recurring themes were then organized under a master theme, and contrasted with each other to differentiate the views common across discussants from those held more uniquely by a particular group. The transcripts were cross-reviewed by different interview teams, to ensure internal consistency. CSD Characteristics of the full sample and across enumeration sites are shown in Table 1. In line with other studies of recent cultural history, we found generally low levels of education and income among the elderly.

Looking across the enumeration site, those respondents recruited in the parks were generally healthier and used to seeking care in both public and private sectors, compared with those recruited from the public clinics who were heavily reliant on the public sector. These differences in demographic and socio-economic characteristics across sites will help to explain the variations in WTP, which are discussed later. Table 2 summarizes key findings on WTP, to co-pay and subsidy requested for each type of private service. A large majority of respondents have used the public sector for general health conditions, thus were asked the subsidy question.

Noticeably, the sum of the voucher and co-pay amounts was still below the market price. Many refused to propose a subsidy amount because they did not want to move to the private sector. When the public—private price gap is smaller e. The WTP survey revealed that most respondents do not have regular health checks or dental check-ups. Table 3 shows the mean WTP for private services by different groups of respondents. Prior experience using the private sector consistently plays an important role affecting the valuation for various services: those respondents who usually visit private doctors for the particular service were significantly more likely to pay than were those who usually visit public doctors.

Those who attained higher education levels and those with higher household income were willing to pay more for private services; so were those who were married or in better health condition, and the differences were significant for most types of services. No significant differences in WTP were seen by age or gender of the respondents, except in the case of dental check-ups probably driven by likely loss of all teeth among older elderly. We estimated both OLS regressions and Heckman two-step models for each type of service.

In general, the multivariate results confirm the patterns observed in the bivariate analysis. Due to limited space, we report only results from the Heckman model of WTP for general health conditions in Table 4 , taking into account the sample selection for zero WTP results for chronic conditions and preventive care as well as those from the OLS regressions are available upon request.

The upper part of Table 4 shows results of the consumption equation, where the dependent variable was defined as the log transformation of WTP amounts, and the lower part shows results of the participation equation of reporting non-zero positive WTP. Most characteristics of respondents were included as explanatory variables in both equations, since they are expected to affect both decisions.

The usual source of care, however, was only included in the participation equation. Results from Heckman two-stage regression of WTP for using private services concerning general health conditions. Reflecting a large number of non-participating respondents i. The respondents who were older, less healthy, having missing income information, receiving welfare support and using only public doctors as usual source of care were less likely to pay anything for private services, whilst those with chronic conditions who were already using private doctors as the usual source of care were more likely to report positive WTP.

Compared with these results for general health conditions, fewer explanatory variables were found significant in the multivariate analysis of WTP for private services concerning chronic conditions and preventive care, but one factor remained so, which is the usual source of care—respondents who were used to seeing private doctors were willing to pay significantly more. In total, 23 survey respondents participated in four focus group discussions 11 participants in two groups with chronic illness and 12 participants in two groups without. None of the participants had medical insurance coverage.

The focus group discussions confirmed the typical healthcare-seeking behaviour among the elderly—they usually choose to see public doctors for chronic conditions and non-urgent matters, but turn to private doctors for acute illness, mainly because they consider private services to be less affordable, but more timely and convenient, sometimes with more effective results by prescribing better and more expensive drugs.

Because the commodity valued is available in the market and the price varies, some discussants reported that they would come up with a WTP value making reference to charges by a specific private doctor they had seen before. However, ability to pay remains to be a major determinant factor of WTP. Prices charged by private doctors are considered unaffordable and unpredictable by many elders, which is why they would express a zero WTP for private services and choose to stay in the public sector.

As for the idea to encourage them to use more preventive services, discussants suggested the Government should provide additional designated subsidy instead of requiring them to use current vouchers for preventive services alone , or directly fund the service, for example, a free health check per year.

Although the subject of this study is WTP, it differs from the traditional CV method in several important ways. Third, the main objective of this study is not to achieve perfection with the WTP estimate—there is less need for that since real market for the valued commodity already exists—but to provide evidence for guiding future policy development, particularly to suggest appropriate subsidy and to design effective incentive. Nevertheless, some of the limitations of CV still apply. Our study may be less affected by this problem, since a reference of current market price range was provided Smith and some respondents had prior experience to guide their valuation.

The fact that some of our WTP estimates actually fell out of the boundary of the reference value suggests that anchoring bias may not be as strong an influential factor as other considerations of respondents, such as the ability to pay. CV results are also found to be affected by the questionnaire format e. Finally, there are a few caveats unassociated with the CV method.

As motivated by a particular policy, our study focuses on the elderly population, whose valuation of private primary care services may be very different from other populations, as the perceived health gain and economic return of healthcare services vary by age. In addition, the lack of a population register forced us to draw a convenience sample instead of a random sample of the target population. Some questions were only asked of certain sub-groups of respondents as well. Despite the aforementioned limitations, we do believe this study has important implications for health policy development in Hong Kong and elsewhere.

The finding of low levels of WTP and high levels of subsidy requested among Hong Kong elderly for private primary care services, especially for chronic conditions, coupled with the generally high resistance to moving from the public to private sector and the low awareness of preventive care, has far -reaching implications for further promotion of primary care and development of public—private partnership around the world.

It implies that promoters of primary care need to raise awareness so as to increase the demand for primary care. Findings from both descriptive and multivariate analyses underscore the critical role of participation decision—many elders would not consider private services at all when same service is available in the public sector, in which case, any economic incentive would have little impact. However, we also found a wide range of WTP across respondents and certain individuals e.

This suggests that some people could see the value of receiving care including preventive care in the private sector. Perhaps it is these people that incentives could target to better induce changes in health-seeking behaviour, while the Government could focus the public resources to serve low income and more vulnerable populations.

This again stresses the importance of public education and word-of-mouth advertising. Once a group of individuals are incentivized to use more primary care services in the private sector, there can be a ripple effect to further extend it and perhaps in the end form a culture that benefits everyone. In addition, the political expedience of the introduction of the Elderly Health Care Voucher Scheme, the lack of evidence for the original incentive design before implementation and consequently the less-than-expected impact it had on the target population should provide a lesson to other countries that are also undergoing healthcare reforms.

The policy-making process should be based on evidence, instead of rushed to meet the political agenda. Without aligned incentives both economic and non-economic ones , a policy, despite best intention, can fail. This is important, especially for low- and middle-income countries, where resources are much more limited and failure is less of an option than developed economies.

To conclude, the study provides evidence of the utility of WTP to examine demand for primary care in the private sector, which has current policy and programme relevance for the ongoing efforts in Hong Kong to promote primary care and public—private partnership. Like Hong Kong, many other economies in both developing and developed regions are searching for the right public and private balance in providing healthcare services.

The findings of this study may help shed light on designing more effective incentives for such efforts. In addition to increasing publicity and education on the concept of primary and preventive care, the Government also planned to promote, in partnership with private providers, a voluntary, protocol-based health check programme at affordable prices for elderly people. These new developments will be monitored and evaluated in the near future.

What is the most you are willing to pay for a visit to a private western trained doctor including medication cost? Show the payment scale card to the elder. What would be the most you are willing to pay from your own pocket for each health check in private sector? What is the most you are willing to pay from your own pocket for a dental check-up in the private sector? Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.

Sign In or Create an Account. Sign In. Advanced Search. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents. Discussion and conclusion. Willingness to pay for private primary care services in Hong Kong: are elderly ready to move from the public sector? Su Liu. E-mail: sliu cuhk. Oxford Academic. Google Scholar. Carrie H. Olivia H. Sian M. Article history. Cite Citation. Permissions Icon Permissions.

Primary care , willingness to pay , public—private partnership , Hong Kong. Table 1. View Large. Table 2. Number of respondents unwilling to pay i. Table 3. Table 4. An exploratory assessment of willingness to pay for health care in Hong Kong. The willingness to pay for wait reduction: the disutility of queues for cataract surgery in Canada, Denmark, and Spain. Search ADS. Hypothetical versus real willingness to pay in health care sector: results from a field experiment.

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Influencing what the money is perceived to be worth: framing and priming in contingent valuation studies. Using willingness to pay to investigate regressiveness of user fees in health facilities in Tanzania. Thematic Household Survey Report No. Socio-demographic profile, health status and long-term care needs of older persons. Census and Statistics Department.

The city has long been considered as a shopping paradise, but industry insiders say Hong Kong has more to offer especially country parks and cultural heritage which can help the city win over other tourist destinations. We have talked to tour operators who take visitors to green and cultural attractions. Hong Kong ranks the fourth lowest in the Smiling Report, which was compiled based on assessments of mystery shoppers in 29 countries and regions. We have spoken to inbound tourists who had unpleasant experience in Hong Kong.

We also talked to workers in service industries to understand what difficulties the trade is facing. In this issue, we have also looked into why some college graduates pursue blue-collar jobs. We have explored whether the opening of the Xiqu Centre can rejuvenate Cantonese opera, and we have done a profile on a volunteer who has saved thousands of cats. Enjoy the read! Instead of pursuing white-collar jobs, some university graduates choose to follow their passion in career building. Franco is not an ordinary taxi driver.

Franco worked as a tutor for five years before he became a taxi driver. What attracted him to be a taxi driver was the high degree of autonomy. But when you are a taxi driver, the power hierarchy is reversed. Despite having higher academic qualifications, Franco still has to learn from experienced taxi drivers. He appreciates how the experienced drivers observe and analyse traffic patterns of passengers.


Looking back, Franco firmly says that he does not regret going to university. For him, the functions of university education are to nurture critical thinking skills, and more importantly, interpersonal skills. But a certificate does not mean a promising future. He cites the case of Steve Jobs, who had already found his own talents before dropping out of college. With a clear direction in mind, Jobs further explored his potentials and made ground-breaking inventions. Others may not agree with his choice, but his way of living gives him a sense of accomplishment.

According to a report conducted by two political groups in , Franco is not the only case. When she returned to Hong Kong, she was disappointed with the one-way teaching approach. She decided to explore more outside lectures. She later learnt she was actually very interested in tattoos. During her first year of studies at CUHK, she travelled to Thailand, where she had her first tattoo on her wrist. After that, she started to get several more tattoos, such as a shuttlecock, to remind herself of her passion in life.

When asked about the meanings of tattoos, she believes it is a form of commitment. As she loved how tattoos are conduits of her self-expression, she started to consider the possibility of being a tattooist. She looked up for information online and found herself a mentor in tattoo painting. As a dedicated mentee, she treasured every opportunity to observe and learn. Comparing with her time in college, she says learning from her mentor was more down-to-earth. Other than teaching practical skills, her mentor also shared his views towards life.

It was the first time when her values were recognised by a senior. Despite so, she still believes university education has its values. She used to think there is only one solution for every question, as she studied science in high school. But from the eyes of social scientists, there are many possible answers to one question. The new insights have transformed her into a more open-minded person. From the examples of Franco and Ko, some may draw a conclusion that university degrees are not really necessary. However, some occupations favour employees with higher academic qualifications. While there is no significant difference in starting salaries of a degree and a non-degree holder, a university certificate is a prerequisite if one wants to work in the Hong Kong Marine Department.

Although the programmes by PolyU and MSTI both cover shipping and logistics, they differ significantly in the curriculum. However, Tsang says a promising career is still attainable even for sailors without a degree. Some higher-ranking positions, such as captain, chief officer and chief engineer, do not require a degree. The government offers comprehensive support to cater to the needs of low-skilled workers. According to a written reply from Employees Retraining Board ERB , it funds and co-ordinates a network of 80 Training Bodies, providing around training courses across 28 different industries.

The courses by ERB target employees aged 15 or above, with educational attainment at sub-degree level or below. In other words, university graduates are not eligible for application and are only accepted under special consideration. Growing popularity of make-up artists in the labour market. University graduates have joined private institutions for retraining opportunities.

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Many of their students are university students, and some are banking professionals. Apart from in-class learning, students can gain hands-on experience by working as helpers in freelance jobs. A career as a make-up artist has gained more recognition in society. Lau thinks it isvery difficult to make a living as a full-time artist in Hong Kong because of unstable income and keen competition. Making art in Hong Kong is also very costly.

Lau also says it is hard for full-time artists to make ends meet if they lack the necessary connections in the art industry such as gallery owners or curators. He says artists have to work day and night to build their career. He says some of the artists try to create commercial artworks that are welcomed by the market for more stable income. He specialises in Chinese painting now, an art genre that is relatively popular in Hong Kong. But the income is unstable, as they can only afford to hold one or two exhibitions with around 30 paintings in each event every year. There is no guarantee that the sales will be good in every exhibition.

Fung now takes up a part-time job as an event campaigner for more income. Only 19 out of the 1, applicants were admitted to the fine arts programme at CUHK in Despite the small intake of fine arts students at the three universities, there is no guarantee that the labour market can accommodate all to graduates each year. Zhang Jiayu, a Year Four CUHK student, who changed her major from cultural management to fine arts, aspires to be a full-time artist after graduation.

However, Zhang reckons that chances are slim. She says career support for fine arts graduates from her school is insufficient. Even though her school has introduced a summer internship course this year, Zhang says other parts of the curriculum are note practical enough to help them develop future career in the field. The university can provide more support to help us better understand the dynamics of the art field when we are still in school.

Professor Ho Siu-kee, Director of M. Nevertheless, they have the responsibility to provide support to help students build their career.

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He says universities should train students to put classroom knowledge into practice. Students can learn the dynamics and updates of the art industry by talking to them. Ho says the Department of Fine Arts at CUHK also tries to do as much as it can to offer practical training to help students gain exposure.

Students are invited to work as helpers for some foreign artists and at some art events. But he says a better way to let students learn more about the work of artists is to allow them to get involved in art projects at schools. HKADC also provides overseas and local internship opportunities, and operates an online platform providing job market information — though most of the posts are not related to art creations.

Ho thinks the government should also provide more financial support for students to join university-wide exchange programmes in which they can meet and build more connections with foreign artists around the world. He also says a government fund should be set up to support non-mainstream artists whose works are yet to be accepted by the commercial market.

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He says such a move can help diversify development of the local art field. Anxious mainland parents with children studying in Hong Kong find comfort in chat groups. Which hostel is a cheaper option? When mainland students leave their hometowns to study in Hong Kong, a city different from any other cities in the Mainland, their parents across the border are anxious to learn how their children are coping in Hong Kong.

These chat groups allow parents to keep their fingers on the pulse of what is going on in Hong Kong, information about the latest programmes, exchange and internship opportunities.

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  5. These parents then share such information with their children. They also seek comfort from each other in the chat group, as they all have to bear separation from their children who lived under their care for nearly 20 years. For example, some parents post group pictures of students took in orientation camps. When other parents recognise their own children in these pictures, they will start talking about their children who joined the same event in the chat group.

    Its original intention was sharing experiences of getting a student visa since the application procedure was complicated. Little did she expect the group would grow to more than people in just six years. She is now frustrated about having too many people in the chat group, as it is difficult to manage. However, she still thinks the chat group is beneficial for parents in the sense that they can learn what their children are doing.

    He says joining the group is a channel for him to express his care for his daughter by learning the updates about her school. She says the group can help reassure her parents that she is doing fine in school, because it is impossible for her to keep in touch with them every day. Lau points out family support is important for university students. She believes the right way for parents to support their children is to have empathy for their children and communicate with them, rather than to completely take over and directly engage in their lives.

    And children need to learn to be independent and update their parents about their school life on a regular basis. Wang Jiying, a year-old Chinese student, who studies in the United Kingdom, travelled to Hong Kong earlier this year. High expectation of her Hong Kong visit turned out to be very disappointing. Lin Shih-hsiung, a Taiwanese tourist who visited Hong Kong two years ago, had similar experience at a chain restaurant. He says a waiter was very impatient and unfriendly when he tried to order his food.

    He was shocked and felt unwelcomed. The government launched a campaign featuring pop star Andy Lau to promote and encourage quality customer service in Hong Kong in However, after nearly two decades since the advertisement was first aired, the city still fails to serve tourists with a friendly smile. Hong Kong ranks the fourth lowest in the Smiling Report, a survey which was compiled based on assessments of mystery shoppers in 29 countries and regions. The smile score, from 0 to , grades quality of customer service. Meanwhile, the Consumer Council told Varsity that the number of complaints from Mainland tourists surged by 93 per cent in In a survey conducted by PTT, the biggest online forum in Taiwan, netizens voted Hong Kong as their most hated city in the world.

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    Page administrator who named herself as Mary Little Two has been working in the catering industry for more than a decade. Most of them are also frustrated by their heavy workload. Tsoi Chung-kin, chairman of the Retail and Wholesale Trades Employees Association, agrees that overwhelming workload has adverse impact on service quality. A waiter now is responsible for taking care of 10 tables of customers, compared with three to four before. Hong Kong is infamous for long working hours and that could be another reason behind poor customer service in the city.

    Tsoi says some workers in the service industry may have to work 12 hours a day, from 10 a. Tsoi says sales assistants at shops or boutiques in tourist areas are prone to long working hours, making it even more difficult for employers to recruit and retain talents. In a bid to recruit more new blood, Tsoi says shop owners should consider giving workers a pay rise.

    He says a wage increase is the most effective way to improve the high turnover rate of the retail industry. Tsoi also says employers should step up effort to improve working conditions in the retail industry. He says arranging resting time for employees is particularly important to let them recharge themselves.

    In , the Labour Department issued a guideline encouraging employers to make suitable rest break arrangement with their employees through negotiation. But Tsoi says it is far from enough, as the guideline is not mandatory. Tsoi adds that shoppers, especially tourists, have a higher expectation of service quality nowadays.

    They do research about products they want to purchase and ask for information from shop assistants. He reminds employers to deploy more resources to offer training for their employees. Cheung Lai-ha, General Secretary of the Retail, Commerce and Clothing Industries General Union, says retail workers should be given more time and resources to enrich themselves by acquiring new knowledge about their work. Long queue for tables in restaurants, crowds, trash, and influx of tourists, are upsetting the quiet and cozy Tung Chung. Tourists have flooded the distant town recently and many residents are annoyed and frustrated.

    Christina Ho, a Tung Chung resident, complains the influx of tourists has caused disturbance to her daily life. Hong Kong is one of the most popular travel destinations in the world. In the past five years, the city of 7. Despite the enormous economic benefits brought to the city, nuisance caused by tourists has become a headache for residents. Conflicts between residents and tourists arose in Tung Chung after the opening of Hong Kong-Zhuhai-Macao Bridge HZMB last year, which attracted hundreds of flag-wielding one-day tour groups flocking to Tung Chung, the closest residential zone to the port facility.

    Mainland tourists who came on public transport swarmed into the town and caused disturbance, leading to a series of protests. In the wake of the situation, the Transport Department introduced a new measure in November last year, requiring tour agencies and group organizers to purchase shuttle bus tickets through a pre-booking system to regulate traffic flow for some specific days. No prosecution has been made so far. Lau suggests the government sets a daily quota on a number of cross-border coaches to put a halt on the influx of tourists and advise the Mainland authority and travel agencies to remind tourists to behave themselves.

    Similar problems also are observed in To Kwa Wan where crowds of tourists flood the district every day. He admits the restaurant only accommodates Mainland group tours, even though it is situated in a local residential area. Cheng, a resident who has been living in To Kwa Wan for 30 years, says many restaurants only serve mainland tourist groups in a shopping mall. Cheng also worries these package tours may ruin the reputation of the city.

    Nette Tsang Wing-tung, spokesperson of a concern group, Synergy Kowloon, says long queue of travel coaches places significant traffic burden on To Kwa Wan. She has seen police officers putting barriers in crossroads to manage crowds of tourists to queue outside a restaurant, forcing students on a school bus to get off in the middle of the road. Tsang says even if a tourist breaks a law and receives a penalty ticket, they can still leave Hong Kong without paying a fine.

    To alleviate nuisance brought by inbound tour groups, the Kowloon City District Council has launched a pilot project to recruit tourism ambassadors to station in the district since The ambassadors are responsible for keeping the environment clean and advising coach drivers not to pick up, drop off or park illegally at popular gathering spots. They can also call upon law enforcement agencies to take follow-up actions on-site.

    However, Tsang doubts the effectiveness of the project, as there are reports about some ambassadors failing to do their duties due to lack of supervision from the authority. She suggests that the government should collects tourist tax and requires souvenir shops to obtain operation permissions after a thorough assessment and public consultation. Apart from buying souvenirs, tourists enjoy visiting local photo spots. Choi Hung Estate has become a hotspot.

    Renowned for its colourful and vividly painted housing blocks, a picture taken in the estate won the Sony World Photography Awards in She says it is a widely recommended picture-perfect place, but she does not find the spot very special. Chen says some residents of other public housing estates do not welcome tourists to take pictures. Lorraine Lee, who has lived in the estate for five years, thinks it is fine for tourists to take pictures inside the estate.

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    The internet fame of the year-old public housing estate also comes along with public nuisance and privacy concerns. Wu says the use of drones equipped with aerial cameras make residents feel worried, as bathrooms are near the balcony side. In the wake of the situation, the Housing Authority provides a guideline to prohibit the use of drones. But Wu believes the effect is minimal and stresses the authority has no right to forbid tourists from visiting the estate. Wu says all he could do is to ask security guards to remind visitors to behave during peak hours.

    He hopes online media will stop promoting the estate as a tourist spot. Love is the Answer. Longing for Belonging. All May — Bon Voyage? Periscope May — Bon Voyage? Sprouting New Markets. A Hospitable City? Rage against Tourism. Take a U-Turn. Artist Career: Viable or Impossible? Let Them Grow. Gap Year: Work or Travel? Looming Threat of School Bus. Behind the Masks. Catch Me if You Can.

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