Generation 40s – 四十世代

Good articles for buddies


Leave a comment

Hospital Authority passes health test

South China Morning Post
Comment›Insight & Opinion
2013-09-12

Alex He Jingwei

Alex He says Hong Kong’s health governance system may not be perfect, but problems can be dealt with through fine-tuning and improvements rather than by scrapping the Hospital Authority, as some suggest

In mid-July, a legislator’s motion on dissolving the Hospital Authority, the statutory body for managing all public hospitals and institutions, stirred widespread debate on Hong Kong’s health policies. Although the motion did not succeed in the Legislative Council, heated discussion still goes on.

A committee set up by the government late last month is due to review the authority’s performance, but even this has proved contentious; controversies about its membership have arisen. Hong Kong has a world-class health system financed by taxes with very low patient fees. Is an overhaul of its health governance system really necessary?

Criticism of the Hospital Authority usually takes three forms. First, that the quality of care and patient satisfaction have declined, mainly due to long waiting times; second, the uneven allocation of resources; and third, there are still staffing and infrastructure shortages, while the private sector’s potential to provide services has not been fully utilised.
We can’t blame patients for visiting hospitals too often … but the ‘free lunch’ syndrome persists

However, these problems are attributable to a series of systemic glitches that can be corrected, rather than fundamental flaws in the design of the authority.

Long waiting times are quite common in most health systems financed through taxation, and the situation in many other countries is a lot worse than in Hong Kong. In Canada, for instance, a patient has to wait four months, on average, for an MRI scan, while the average time for a knee replacement is almost a year.

We can’t blame patients for visiting hospitals too often because they have medical needs, but in most public medical systems, the “free lunch” syndrome persists. This leads to overutilisation. As seen in Taiwan, overuse has led to less efficient allocation of financial resources because some patients may not actually need that much tertiary health care.

In theory, it’s possible to prescribe very straightforward policy advice. On the demand side, an increase in out-of-pocket fees would deter overuse of the system and thus reduce waiting times. But this is unrealistic in Hong Kong’s current political climate; any such suggestion would meet overwhelming public opposition, a lesson learned from the frustration of past public consultations.

Yes, something could be done on the supply side, by enhancing the capacity of the public system or establishing new hospitals, for instance. Unfortunately, both need a long time to take effect, not to mention the constraints on the training capacity of local medical schools.

Some have called for private hospitals to have a stronger presence in Hong Kong, which could create pressure for public hospitals to improve performance on one hand, while absorbing a large number of patients from the overloaded public system, on the other. The new private hospitals under construction reflect the government’s long-term planning for the health system.

However, it should be noted that few people other than the rich would benefit from more choice in the private market; millions of middle- and low-income residents would still be left with no choice but the public system.

With or without the Hospital Authority at the top, the health governance system is not responsible for this socioeconomic reality. In recent debates, the concept of “money follows the patient” has merited attention. Researchers generally agree that subsidising the demand side, that is, patients, tends to be more efficient than pouring taxpayers’ money into public hospitals. Hong Kong is not short of successes in this regard. The Health Care Voucher Scheme, introduced in 2008, is a good example. It encourages the elderly to use private facilities by offering them annual subsidies of HK$250, which was increased to HK$1,000 after the pilot scheme showed positive results.

Given Hong Kong’s rapidly ageing population, longer life expectancy, increasing demand for quality care and the heavy pressure on public facilities, adopting similar demand-side schemes has to be a promising policy option. It would not only help relieve the pressure on public hospitals, it would also contribute greatly to the government’s long-term agenda of poverty alleviation and social protection.

Some critics of the Hospital Authority contend that a centralised governance structure is inefficient, and point to the HK$1 billion budget for its headquarters. However, health care is very prone to market failures, which makes government regulation indispensible. This is why the government’s belief in non-interventionism did not prevent the formation of a strong central statutory institution. In this regard, our East Asian neighbours offer lots of lessons. South Korean health care, for instance, is dominated by private facilities. This has not only made it harder for the state to correct market problems, but has also fuelled cost inflation.

In contrast, Taiwan’s system has been lauded as one of the world’s best, the key reason being that the National Health Insurance Administration – as the single purchaser of health services – is in a strong position to guide hospitals, seek compliance and ensure policy objectives are met.

Hong Kong’s health governance system is not perfect, but its overall performance provides strong justification for the Hospital Authority to continue to exist. Seven major mainland cities, including Beijing, Shenzhen and Chengdu, have followed Hong Kong’s path and created their own hospital authority as a key initiative to drive their health system towards centralised and professional regulation.

The issues that have emerged in recent debates largely point to systemic glitches that can be corrected through fine-tuning and continuous improvement, rather than reflecting a fundamental institutional dysfunction.

Dr Alex He Jingwei is an assistant professor in the Department of Asian and Policy Studies at the Hong Kong Institute of Education


Leave a comment

基金回報是技巧還是運氣?

Hong Kong Economic Journal
B03 | 專家視角 | 經濟3.0 | By 曾國平 |
2013-05-11

昨天跟讀者介紹金融學家夏普(William F. Sharpe)提出的一個簡單道理,指出積極型投資者和只跟隨大市指數的消極型投資者,在任何時候的平均回報都跟大市表現相若,但由於前者買賣比較多,付出的交易費用比後者高,於是平均而言必定跑輸大市。夏普的推論只用上簡單的數學,舉一個例子讀者就能明白。

假設市場上只有兩家上市公司A 和B,每家公司各有10 股股票在市場流通,A 今天股價是5元,B 股價是10元,股票市場的總市值是150元。假設市場上只有甲、乙、丙、丁四位投資者,甲是消極型投資者,只買進A 和B 的股票各1 股;乙、丙、丁則比較積極,各自根據消息和獨特眼光,買賣每家公司剩下來的9股股票。

一年過後,A 的股價升至9 元,B 的股價則升至12 元,市場的總市值增加至210 元,大市回報是40%。甲的回報是多少?甲手持的投資組合由15 元,升至21 元,回報跟大市一樣。至於乙、丙、丁,一年之間可能交易無數,但三人持有的股票最後必定是公司A 和B 各9 股。三人之中或許有人回報高於40% 、也有低於40%的,但三人的平均回報亦必定跟大市一樣為40%!

不過,乙、丙、丁的交易次數比甲多,付出的交易費用較高,三人扣除該些費用後的平均回報,必定比甲要低;就算乙、丙、丁三位投資者一點也不積極,只在一年前交易一次,三人扣除費用後的平均回報也只能跟投資者甲打個平手。

夏普的答案應用於市場內所有的積極型投資者,從散戶到基金都包括在內;若果只考慮積極型基金,情況會否有所不同?

這正是金融學界中的「最佳拍檔」法瑪(Eugene F. Fama)和弗倫奇(Kenneth R. French)在2010 年發表的一篇文章內所關注的問題【註】,兩位作者考核了1984 至2006 年一眾積極型美股基金(即非指數基金)的平均表現,再推算出可有個別基金的表現特佳。

每個月逾千隻的積極型基金裏,有些基金風險較高但回報亦較高(如只買進「蚊型股」的基金),有些基金風險較低但回報亦較低(如只買進藍籌股的基金),兩者能比較嗎?縱使前者跑贏大市,但投資者要承受比大市極端的上落,我們不能因此認為前者比後者優勝。正確的做法是,先把基金因風險而來的回報扣除,剩下的回報跟風險無關,基金表現的高低便一目了然。

法瑪和弗倫奇發現跟夏普的觀點不謀而合:三十年間積極型基金的平均表現跟大市幾乎一樣,扣除交易費用後的回報更明顯地比大市低一截。

靠運氣機會極低

雖然基金平均看來跟大市無異,但可有個別基金因基金經理的超凡能力而表現突出?兩位作者利用統計方法,推斷出每隻基金的回報到底是靠運氣還是靠實力。

比如說,你買進的一隻基金三十年來的平均每年回報是6.5%,而同期的大市每年回報是6%,基金的回報雖然比大市高,但兩者的差距卻又似乎不是那麼大。到底0.5%的差距是基金經理技術超群,還是基金經理「撞手神」?統計學能解答這個問題。

根據法瑪和弗倫奇的分析,一眾基金中的確有少部分表現出眾,高回報純粹靠運氣的機會極低── 「星級」基金經理是真有其事。

不過,儘管這些基金回報能跑贏大市,但扣除交易費用後,只能跟交易費用較低的消極型指數基金打成平手!

既然買進指數基金划算得多,市場上為何仍有大大小小的積極型基金,散戶為何仍樂此不疲的繳付交易費用?也許是緊張的交易自有其快感、頻繁的買賣自有其樂趣,非保守沉悶的指數基金所能及!

註:Eugene F. Fama and Kenneth R.

French (2010): “Luck versus Skill in the Cross-Section of Mutual Fund Returns,” Journal of Finance, 65(5), 1915-1947.

維珍尼亞理工大學經濟系助理教授
曾國平


Leave a comment

Officials have always hated Hong Kong’s country parks

South China Morning Post
2013-09-10

Business MONITOR

Tom Holland

There’s no other explanation for recurring schemes to pave over these city treasures, to provide development land we don’t need

Hong Kong government officials have long suffered from a malignant combination of agoraphobia and chlorophobia – a terror of open spaces coupled with an irrational fear of the colour green.

Take our public servants and put them anywhere they are not surrounded by glittering shopping malls, grade A office towers and “luxury” property developments, and they break out in a cold sweat.

Worse, if there happens to be any vegetation around, they begin to panic. Their heart rates shoot up, they start to hyperventilate, their knees begin to tremble and they come over all faint.

Restored to normality again in the air-conditioned cocoons of their chauffeur-driven official cars, they shake their heads as they slowly recover and mutter: “It’s no good, it’ll have to go.”

At least that’s the only explanation I can think of for the government’s long-standing animosity towards Hong Kong’s 24 country parks.

Loved by the city’s population as islands of natural beauty, havens of tranquility, and easily accessible playgrounds away from the urban turmoil of everyday life, Hong Kong’s parks had 13 million “recorded” visitors last year, according to the government.

Given that the vast majority of visits go unrecorded, that means the parks were used many, many times more than that.

Yet our officials are resolutely hostile. Back in 2002, with the city’s property market five years into a cyclical slump, one government genius suggested the best way to plug the Hong Kong’s budget deficit would be to sell off the country parks for property development.

Happily for everyone, that idea came to nothing. Now, however, our officials are at it again. In his blog last week, Development Secretary Paul Chan Mo-po suggested that Hong Kong’s country parks could be built over for housing.

The argument officials advance privately is that the city is desperately short of building land. If the government is to build the 470,000 flats Hong Kong needs over the next 10 years to alleviate its acute housing shortage, then developing country-park land is the only option.

This is nonsense of a high order.

First, let’s examine the notion that Hong Kong needs 470,000 new homes.

According to the government’s own forecasts, the city’s population is set to increase by some 484,000 souls over the next 10 years.

Accepting the official projection that average household size will fall from 2.9 to 2.8, and factoring in the disproportionately rapid growth of small households, that implies the formation of 300,000 new households by 2023.

Even allowing for a charitable estimate of the numbers currently living in sub-standard conditions who need to be rehoused, and factoring in a faster rate for the demolition of old housing, it is hard to imagine that Hong Kong’s demand for new homes over the next 10 years could exceed 350,000 flats – a far cry from the 470,000 flats the government wants.

If we then assume these 350,000 new homes are built at a density of just 500 per hectare – generous compared with densities of up to 1,030 per hectare in the government’s new towns – then the total land area required for building comes to 700 hectares, or seven square kilometres.
Hong Kong boasts plenty of spare room to build on without going anywhere near the country parks

Even the government’s 470,000-flat plan would need less than 10 square kilometres.

A quick glance at the Planning Department’s figures for land use shows that Hong Kong boasts plenty of spare room to build on without going anywhere near the country parks (see the chart).

For example, 16 square kilometres are currently classed as vacant, with a another 16 square kilometres used for warehouses or “open storage”. The government itself occupies 25 square kilometres.

And there is an enormous 342 square kilometres of scrubland, woodland, grassland and agricultural land (which excludes both villages and golf courses) sitting outside the boundaries of the city’s country parks.

In short, there is an abundance of potential building land, and no need at all for the government to consider concreting our treasured country parks.

You can only conclude that our officials must suffer from a deep-seated fear and loathing of undeveloped public spaces.

from SCMP Sep-10, 2013

from SCMP Sep-10, 2013


Leave a comment

問心無愧?

Hong Kong Economic Journal
C02 | 醫情醫說 | 奇妙恩典 | By 陳慧忠 |
2013-05-11

高官面對傳媒的質詢,政客面對其他政黨的指控,貪婪地產商對巿民的辯釋,以至人的行為信念受到衝擊時,「問心無愧」和「公道自在人心」這兩句話往往衝口而出,但說這話的人是否真正相信他所謂公道是否真正公道,心中是否真正無愧?在法律原則上也可有不同標準。西方法律理念下,人權和法律面前人人平等的公平原則下,人人都是innocent until prove otherwise;但在某些政權下剛巧相反,人性本惡,蛇頭鼠眼,窮小子會貪心,有學問就有道理,有錢就高人一等,官字兩個口,在極權人治下人人都是guilty until prove otherwise,除非可以證明自己清白,否則執法權力可以欲加之罪,何患無辭,屈打成招,時有所聞。不同的法制下,同樣行動可以有截然不同的後果,捫心自問,都是問心無愧嗎?

國有國法,家有家規,入國問禁,入境問俗,否則一不留神,糊裏糊塗身陷囹圄也非鮮有所聞。立法的理念亦可以時移世易:雙非孕婦入境從合法到不合法;限奶令下奶粉不能出囗,甚至帶了疑似奶粉者亦犯上官非;在法治社會中,在法律的保護傘下貪贜枉法,以權謀私,都可以問心無愧嗎?法律是僵化又是死板的,執法和判刑懲處,也有酌情權之設,為死板的法律添上人性和人情味,以圖減少問心有愧的可能性。但相反的情形下,人治社會中人性無限上綱,將人的主觀意願凌駕於法律之上,大人先生說了算數,下面噤若寒蟬,小市民只能怨嘆命薄力弱任人魚肉。請問公理安在?

但話需說回來,若果在沒有抵觸法律的灰色地帶下,各人不同的道德標準,也會有不同的理念,迴異的境況經驗,更有在利益衝突下,各持己見,公婆各有各的道理,又應該如何定奪?如果有人以「司馬昭之心,路人皆見」,胡作非為,其心可誅,當然為人詬病;但不少精通心理學法律條文之飽學之士,或是財大氣粗的暴發戶,也可以是官官相衞的官僚政客,或是富可敵國的財閥臣擘,無所不用其極的鑽空子,得其所哉,以醒目靈活自居而沾沾自喜,以歪理拗橫折曲,似是而非的上下其手,剝削社會百姓,瞞上騙下,予取予攜,得到好處後還喜不自勝,更大言不慚「問心無愧」。人性卑劣至此,令人握腕。每個人心底都有良知,也有同理心,是非黑白其實多少都有準則。是對是錯自己最清楚,不過財可昧心,氣可越理,酒可亂性,色也會惑人;越了界沒人知道就以為過了骨,誰不知天知地知,人不知,但自己知,午夜夢迴也會時刻受着良心的譴責。

意念上一線之差

在未有扺觸法律的灰色地帶,行事為人應求問心無愧,因為凡事都看行事的人的動機意圖。有動機的令人死亡就是謀殺,沒有意圖但毀滅了生命就是誤殺;行性感的行為就是色情,用作表達美態舞蹈的就是藝術;女人有意穿着暴露誘惑衣飾的就是引人犯罪,略施胭脂粉表現女性美的就是情趣;為口腹之欲而暴飲暴食就是暴殄天物,但淺嘗細嚼的享受食趣就是神的恩典,能否問心無愧也許是意念上的一線之差,但差之毫釐,謬之千里,善惡正邪是非對錯,也就判若雲泥。香港曾經發生過雕塑風波而貽笑大方,事緣有一件放在公眾地方的裸體男性雕塑被評為色情不雅而驚動傳媒,在二十一世紀國際大都會的香港,竟然還有如此僵化迂腐守舊的頭腦思想,實在令人驚訝。黑黑的一件木無表情的男性裸像,但一看便知放在那地方是用作點綴的一件藝術品,目的是提高環境品味。聲討之道德人士莫非看了便會動淫念乎而要除之而後快。如果聳立於佛羅倫斯的大衛像也遭逢如此的屈辱,Michelangelo 泉下有知,一定死不瞑目。

(「奇妙恩典」節錄自陳慧忠醫生網誌