CHAPTER 1
INTRODUCTION
Medicine is not all, or even mostly, about money. Science, caring, professionalism, and even religious concerns regarding birth and death can be more important than dollars.
Healthcare is among the world’s largest industries, accounting for 10 percent of gross world product, but only a tiny fraction of world trade (Gotten, 2004). Around the world, healthcare institutions are encountering growing pressures from governments, investors and the general public. Healthcare is indeed a more complex economic problem than bridge-building.
Like some other professions but unlike many other goods and even services, it is difficult for the consumer (the patient) to evaluate the quality of services received. Much depends on the self-control and reliability of the individual practitioner, the supplying group, and the medical profession as a whole, in ways that the ordinary patient cannot readily check whenever he/she needs to.
These institutions must simultaneously improve the health and well being of the public, cut costs and remain competitive. To achieve these goals, many healthcare institutions have implemented total quality management (TQM). Evidence from hospital-based studies, however, suggests that the success of TQM is constrained by inadequate information systems and poor application of information technology.
Change appears to be a driving force in society today and the Hong Kong healthcare system is no exception. In addition to the need for change in today’s society, the importance of creativity in bringing about needed change must also be considered. An organisation will quickly lose strategic advantages that it has worked hard to gain unless it invests in innovation and creativity, and consequently, change (Redmond, et al, 1999).
With this respect, the healthcare industry in Hong Kong is an interesting case. Aside from the demand for quality healthcare, there is also a drive to reduce the cost of healthcare expenses. It was reported that the Hong Kong Special Administrative Region (HUSSAR) spent HK.9 billion, equivalent to 15.4 % of total public expenditure in the year 2003-2004 on healthcare (Tsang, 2003). This escalating increase calls for the initiative to reduce costs in healthcare (Tsang, 2003). However, it is perceived that by doing so, the quality of the delivery of healthcare services across Hong Kong will be jeopardized (Tsang, 2003). This poses as a challenge for HUSSAR in managing the healthcare sector. This situation, of course, is also applicable to private healthcare companies in Hong Kong that are anxious to reduce their costs without the hampering the quality of their services.
Based on the paper of Xiao et al, (2002), the industry is facing the problem of not having any effective tools or methods to assess the quality of healthcare delivery in the region, specifically the outcomes of healthcare delivery. Accordingly, valid data describing processes and outcomes of care is central to quality assessment and improvement. Data could be obtained from a variety of sources including administrative databases, medical records, and patient surveys, but the completeness and accuracy of these data systems are often in question (Helper, 1996; Arts et al, 2002). This questions the ability of healthcare companies in effectively managing their turf, and in the long run, ensures that they are capable of delivering quality healthcare services to their clients. Measuring the outcome TQM in health care industry is not the only problem, but also which management methods or strategies they should and would implement. There are other issues that need to be considered such as structures and patient satisfaction. Andale (1998) stated that the health care industry of today experiences forces of changes that include competitive pressures, alternate health care delivery mechanisms, changing cost structures, monitoring by public and private groups, increased information availability, and a markedly better-informed clientele. For instance, in a specific public opinion poll, 48 per cent of Americans have had personal problems with managed care or know someone who had a bad experience (Kaiser Family Foundation/Harvard University, 1998). In Hong Kong, on the other hand, it was reported that there are evidences of inappropriate prescribing practices, as well as an overall lack of integration resulting in discontinuities throughout the healthcare system (Yip et al, 1999). Yip et al (1999) found in their research that in the Hong Kong healthcare industry, there are no formalized processes for providers in one sector to communicate vital patient specific information to providers in the other sector. Furthermore, the medical records rarely follow patients across the sectors so patients themselves must assume the lead role in relating their histories, diagnoses and treatments to new doctors and nurses, and that follow-up care lacks a high degree of integration, such as for older groups suffering from stroke (Yip et al, 1999).
From the previous discussion, this paper investigated the effect of ulcers to weak elders. As part of the of the changes and development in health care industry, this paper attempted to conduct an in-depth analysis to the quality of life that an individual face at his/her old age.
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