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Public Policy Research - Layman summaries of projects funded in 3rd Round

HKUST 1001-PPR-3
Do-Not-Call Registry and Marketing Solicitations in Hong Kong
PI: Dr Kai-lung Hui

The research conducted in this project is a pioneering effort to integrate the benefits and costs of all related parties (marketers, the government, and consumers) in a coherent framework. As such, our analyses are robust and balance the needs and concerns of both the buyer-and seller-side of market (unlike studies conducted by the marketing industry, which tend to focus more on the needs of marketers to advertise, or those by consumer advocates, which tend to focus more on consumer privacy). We conducted extensive analyses in both the theoretical and empirical domains, and from there drew pragmatic public policy suggestions that can be directly implemented in Hong Kong. We also studied the experience of the USA in implementing the "do not call" registry, and we concluded that similar privacy protection initiatives may receive good support in Hong Kong too. This project provides a useful framework and methodology to analyze similar privacy-protection initiatives in the future, and it serves as a useful reference for devising public policies related to consumer privacy in the future.

HKBU 2002-PPR-3
Protection and Redevelopment of Agricultural Soil in Hong Kong
PI: Prof Wong Ming-hung

With the increasing public attention to food safety, Hong Kong's agriculture is facing an awkward and embarrassing situation - as imported crops contaminated with toxic substances have been sold within the territory while a considerable number of farmlands in the New Territories have been either abandoned or used as dumping sites for wastes. The lack of research on soil and agriculture in Hong Kong restrains the policy-making. It is the right motivation for conducting this project.

The result reveal that Hong Kong has a potential to redevelop its agricultural sector for ensuring a satisfactory supply of safe and high quality crops, since most farmlands in the NT are fertile and suitable for crop growth. The soil is also clean and free of heavy metals and POPs contamination except several sites for storing and open burning of e-wastes. However, the residual concentration of DDT in some sites still remains high. Remediation for the contaminated sites is a must for ensuring a safe agricultural production. In addition, the redevelopment of agriculture would provide more employment opportunities since agriculture is a labor-intensive industry. Our survey demonstrates that a farm of 1000 m2 can create two working positions and generate HK$7,000 net income under traditional mode while five working positions and up to HK$50,000 if running under organic farming mode. Therefore, redeveloping agriculture will play an important role in enhancing Hong Kong's economic prospects and community stability. This will also contribute significantly in minimizing our ecological footprint and carbon budget.

CUHK 4002-PPR-3
Vascular events In noncardiac Surgery patIents cOhort evaluatioN Study (The VISION study)
PI: Prof Matthew TV Chan

Recent advances in medicine have allowed patients to undergo complex surgery. Many of these patients have significant heart disease. There are compelling data to suggest that heart attack and stroke around the operative period are in the rising trend. Much of the existing data are outdated and cannot be extrapolated to current clinical practice. We have therefore conducted a large prospective observational study in 20,000 patients to determine the incidence of major heart events around surgery. We call this study the "Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Study".

The VISION study identified that elderly patient > 70 years, undergoing urgent and major surgery, who has previous stroke or heart problem are at high risk of further heart attack after surgery. These patients should be monitored in the intensive care or high dependency unit. In addition, we found that an enzyme of the heart muscle (cardiac troponin) flowing in the blood stream is useful to detect silent heart attack, that are likely to go unrecognized.

Clinicians and patients are now more informed on the risk of surgery. Data of our study will be included during the informed consent process. We have also identified a number of possible strategies to prevent heart attack after surgery. Future studies will be conducted to confirm these observations.

CUHK 4003-PPR-3
Cost-effectiveness of an outpatient preanaesthetic clinic
PI: Prof Anna Lee

Healthcare systems of today place much emphasis on patient-centered quality outcomes and cost effectiveness. Anaesthesiologist-led preoperative medicine clinics have been established overseas to prepare most elective surgical patients for anaesthesia and surgery. However, the development of preanaesthetic clinics in Hong Kong public hospitals has been slow and its cost-effectiveness is unknown. This study compared the perioperative costs and effects of patients assessed by the anaesthesiologist at the clinic (new system) versus on the ward one day before surgery (traditional system). The patients in each group were matched by the same surgical procedure and baseline differences were adjusted for in the statistical analysis. Compared to the traditional system, clinic patients were more informed about the risks and process of anaesthesia, had higher preoperative patient satisfaction levels and stayed one day less in hospital before surgery. There was no difference between the patient groups for the quality of recovery from anaesthesia and surgery. Three quarter of the study sample strongly preferred to have their preoperative anaesthetic assessment at the clinic, and they were willing to pay about HK$170 for the clinic consultation. Our findings suggest that the preanaesthetic clinic is likely to be cost-effective.

PolyU 5006-PPR-3
Rehabilitation Needs of People with Schizophrenia and their Caregivers in Hong Kong: Implications for Public Policy
PI: Dr Hector Wing-hong Tsang

Schizophrenia has devastating effect on the quality of life of the clients and their caregivers. Existing policies are not up-to-date and rehabilitation services for these two groups of people are inadequate. In order to formulate appropriate policies and develop quality rehabilitation services, assessing their needs using a scientific approach is of utmost importance. The findings of this study have identified the rehabilitation needs and priority of people with schizophrenia and their caregivers in Hong Kong. The findings serve as empirical information for the government of the HKSAR to formulate policies and prioritize resources on the provision of psychiatric services for these two groups of people. Main recommendations include allocation of more resources in terms of funding and manpower, provision of quality rehabilitation services such as family intervention and psychotherapy, empowerment of people with schizophrenia and their caregivers by developing channels to solicit their opinions in developing mental health care policy and rehabilitation services, formulation of policies and strategies to reduce social stigma on mental illness, and provision of public education on mental illness.

HKUST 6001-PPR-3
Making cultural cluster: New strategies for culture-led urban redevelopment
PI: Dr Chen Yun-chung

This research studied four "potential" cultural clusters in Hong Kong, i.e. Wanchai, Central, Cattle Depot and Tsim Sha Tsui South. We found that the networks among art and cultural actors and between art/cultural actors and the local neighborhoods are weak. The main reason is a weak market that cannot support a large pool of full-time artists and elaborated division of labor. The structural causes of the weak markets are:

(i) the lack of a cultural bureau and cultural policy to promote art education and audience building,

(ii) the lack of standard (maximum)working hours and minimum wage ordinances resulting in long working hours, which hinder Hong Kong people's participating in leisure and cultural activities.

We also found the lack of trust and collaborative platforms in the clusters among the artists and between artists and community organizers. To support a vibrant cultural clusters with the support of community, the Hong Kong government should learn from the Taiwanese experience in their community building initiative called “Holistic Community Building” (社區總體營造) that began in 1994. Continuous funding and technical assistance (such as the community planner and architect program) is granted to culture-cum-community development projects initiated by local communities and artists.

HKU 7002-PPR-3
Is there a need to promote family medicine concept in Hong Kong? - Meeting the need for recognition and treatment of depression as a model
PI: Dr Lam Tai Pong

This study tries to find out how the public and medical profession sees the role of family doctor/medicine in providing healthcare services. Based on opinions collected through small group discussion and large scale telephone/questionnaire survey of the public and doctors respectively, the study shows that the promotion of family medicine in Hong Kong will not only meet the public expectation of having a regular doctor whom they can trust and continuously see when in need, but also enhances the family doctor's role in the continuity of care, prevention, gate keeping and providing comprehensive care. The achievement of which will help lower medical cost and expenses, avoid unnecessary investigations and achieve better health outcomes.

The study also informs policy makers about the feasibility of developing the one-citizen-one family-doctor healthcare model and strategies to maximize the benefits of family medicine. Findings from the study support that the public would accept a healthcare system that is based on family medicine while doctors are less optimistic in this regard. It is therefore important that training in family medicine be available to all primary care doctors, newly graduated or experienced and to optimize current primary care settings to facilitate doctors in both private and public sector to practice family medicine.

HKU 7010-PPR-3
Long-term care cost drivers and expenditure projection to 2033
PI: Prof. Gabriel M Leung

Our findings show that, in contrast to health care spending, demographic effects such as changes in the population structure brought about by ageing are more important in driving LTC spending growth than other changes such as unit cost growth of different LTC services. In short, rapidly-aging Hong Kong will inevitably bear an increasing LTC burden, unless there is an unanticipated change in its population policy vis-ˆj-vis substantially increased immigration of younger individuals from the mainland (thereby enlarging the productive workforce supporting the retired cohorts) or mass emigration of local retirees.

The coming 5-10 years will be an important window of opportunity to develop policies to cope with the LTC burden alongside with the issues of health care financing and retirement planning. Irrespective of the eventually policy responses to Hong Kong's ageing population thus LTC need or demand, the reliable prediction of the associated financial liability in the medium to long run, as presented in this study, adds to the evidence base from which such can begin to be formatted and debated.

HKU 7011-PPR-3
A study of the domestic violence costs and service utilization in Hong Kong
PI: Dr Ko Ling Chan

The present research aims at bridging the existing research and information gaps with regard to the cost analysis of domestic violence and violence prevention/intervention programmes in Hong Kong. The objectives of the study are to identify the service utilization pattern of the perpetrators and victims of spousal violence in Hong Kong; to assess the impact of service utilization on spousal violence in terms of severity, types and chronicity; to identify the factors associated with help-seeking or the service utilization pattern of spousal violence perpetrators and victim; and to develop a cost model of service utilization for the assessment of the costs and benefits of prevention and intervention programmes to inform policy-making, especially with regard to the design and implementation of publicly funded programmes in Hong Kong.

The study provides empirical data to study the pattern and correlates of service utilization of the perpetrators and victims of spousal violence, economic costs of domestic violence as well as the development of a cost model of service utilization for the assessment of the costs and benefits of prevention programmes. Information obtained from the study will facilitate evidence-based planning and implementation of these programmes, and provide an economic rationale for resource allocation.

HKIEd 8001-PPR-3
Alternative Policy Instruments for Enhancing Citizenship Education
PI: Dr. Gregory P Fairbrother

The purpose of this research project was to determine the suitability and desirability of, capacity for, and potential obstacles to implementing an independent, compulsory course of citizenship education at the junior secondary level of Hong Kong's education system. To answer the question of whether the Hong Kong government should reform citizenship education curriculum delivery, the project relied upon statistical analysis of an international database of civic education inputs and outcomes among 90,000 14-year-olds in 28 societies as well as interviews with 67 education leaders, principals, and teachers in Hong Kong schools. The findings of the research suggest that a potential government mandate of an independent subject of citizenship education in the school curriculum would not deliver substantial benefits for students' learning of civic knowledge, knowledge of democracy, and patriotism, and could be met with opposition from the educational community. The government's mandating citizenship education to be compulsory for all schools would also not deliver substantial benefits at the cost of reform. In sum, there is little support from the research for any manor citizenship education curriculum reform. Instead, the government would be advised to strongly encourage and support a wide variety of curricular and extracurricular learning activities inside and outside schools.