Hong Kong hospitals - the geographical implications of a hospital philosophy.

Abstract

The pressures exerted on hospital facilities in Hong Kong from an ageing population with increasing expectations, are compounded by a continued growth in population. Hospitals have clearly failed to deal with rising demand and, as a consequence, are commonly perceived to be in a state of crisis. In this respect, most comment has centred on the overall quantity of provision and quality, as assessed largely in terms of technical care and hotel conditions. This thesis highlights the additional issue of the spatial inequality of provision in a rapidly changing urban scene. In extending discussion to the "appropriateness" of new hospital provision, the thesis examines the relationship that hospitals have with their client populations. This involves not only their geographical location, but also their interaction with other health care providers in the urban space and, most importantly, the roles which hospitals have been assigned. The thesis explores the link between the function of a hospital and the principles on which the hospital system is based, arguing that the system is not merely a product of a particular politico-economic setting, but also of a history of influences, not least of which has been the need to mediate between the diverse cultures and traditions of Hong Kong. Guiding principles concerning the role and functioning of hospitals can be collectively described as a "hospital philosophy". Because it has arisen out of diverse influences, such a guiding philosophy may be susceptible to change, even though basic economic and political relations remain essentially unaltered. Since a hospital philosophy can affect location decisions and the way in which the hospital interacts over space, any change in philosophy may have spatial implications. The thesis assesses the extent to which the philosophy can be successfully altered from within the system by paying particular attention to the relationship between one hospital, which has proclaimed an alternative approach, and the area which that hospital serves. Also examined are the Government's own plans for changing the operation of hospital services for the 1990s and their spatial implications, assessing to what extent this reflects a significant change in outlook towards hospital care.