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An evaluation on 2007 obstetric service policy in Hong Kong : a solution to the service-seeking behaviour of Mainland pregnant women? Shiu, Wan-yee, Ruby; •µ—ûQ
An Evaluation on 2007 Obstetric Service Policy in Hong Kong – a Solution to the Service-seeking Behaviour of Mainland Pregnant Women?
By SHIU Wan-yee, Ruby June 2007
Degree of Master of Public Administration The Department of Politics and Public Administration Faculty of Social Science University of Hong Kong
I, Shiu Wan Yee, attest that this thesis, ‘An Evaluation on 2007 Obstetric Service Policy in Hong Kong – a Solution to the Service-seeking Behaviour of Mainland Pregnant Women?’, submitted for fulfillment of the Master of Public Administration is fully my own work unless otherwise quoted and cited.
Table of Content Content Page Chapter One Introduction Introduction Undesirable Phenomena Diagnosis to the Phenomena Economic Environment Legal Ambiguity Failure of Charging Policy Government Action Framework of Study Research Questions Methodology Dissertation Plan 1 2 5 5 6 7 9 11 12 12 13 Chapter Two Hong Kong’s Immigration Policy on Mainlanders Introduction 14 Immigration Policy on Mainlander in Colonial Era 14 Entry to Hong Kong for Settlement 17 Entry to Hong Kong for Visit 18 Immigration Policy on Mainlanders after 1997 20 Contradiction between Basic Law and Immigration 25 Ordinance Immigration Ordinance 25 Basic Law 26 CHONG Fung-yung v. the Director of Immigration 28 Chapter Three Diagnosis of the Problem from an Economic Approach Introduction Common Pool Resources Problem of Collective Actions Externalities 31 31 32 34 iii .
Public Obstetric Service in Hong Kong Cost of Giving Birth in Hong Kong I) Short-term costs II) Long-term costs Benefits of Giving Birth in Hong Kong I) Fleeting from one-child policy penalty II) Advanced medical care III) Hong Kong Residency Externalities Policy Before September 2005 Policy After September 2005
38 40 41 41 43 45 45 45 46 48 48
New Policy in February 2007 Introduction The New Policy Increase in Charge Defaulted Payment Prevention Mechanism Centralized Registration System Tightened Immigration Control
51 51 52 53 54 55
Evaluation of the New Policy Introduction What is Evaluation Classification of Policy Regulatory Instrument Economic Instrument Information Evaluation of 2007 Policy Policy Instrument Choice of Instrument Design of Policy Conclusion
56 58 60 60 61 62 63 63 64 68 69
The Way Forward Introduction 71 Long-term Implication 71 Social Disintegration 72 Restructuring of Obstetric Service Policy 73 Reorienting Policy Target 73 Extending Quota Coverage 74 Increasing Charge for Couples who are both 74 non-Hong Kong residents Supportive Measures 75 I) Immigration control 75 II) Defaulted Payment Prevention System 78 Civil Education 78 Vision in Education, Housing, Medical Service and other 79 Welfare Policies Education 79 Social Welfare Assistance 81 Conclusion 82
CHAPTER ONE INTRODUCTION Introduction In the past five years, the number of Mainland women coming to Hong Kong for obstetric services has risen from 7810 cases in 2001 to 20,577 cases in the first ten months of 20061. The percentage to the number of local pregnant women rose from Before 2001, majority of Mainland women came to
16% in 2001 to 39% in 2006.
Hong Kong for obstetric services were wives of Hong Kong males. While in recent years, there was an upsurge in the number of Mainland women, whose husbands were also Mainlanders, came to Hong Kong for giving birth. Among the 20,577 Mainland
women giving birth in Hong Kong, 61% of them were married to non-Hong Kong residents. Detailed figure on the number of birth by Mainland mothers in Hong Kong appear in Annex A.
With only eight public hospitals providing obstetric services in Hong Kong, handling around 42,000 deliveries per year 2 , the large influx of Mainland women poses significant pressures on the scarce health care resources in Hong Kong. Some public
Discussion Paper on ‘Impact of the use of Obstetric Services by Mainland Women on Public Hospital Resources’ by Legislative Council Panel on Health Services. (8 January 2007), LC Paper No. CB (2) 761/06-07(03). 2 ‘Hospital booking rule for Mainland mothers’, Global News Wire - Asia Africa Intelligence Wire, 2007-01-17. 1
(2006-12-8) “港婦：被迫開刀分娩 確保有牀位”. There were reports that that more than one woman gave birth in one delivery room at the same time. Some did not receive the same amount of prenatal checks as they used to have. some pregnant women deliberately chose to deliver their babies by surgery instead of natural labour just to secure a stay in the hospital. 3 4 ‘醫管局擬五招防病人走數’. Apple Daily (2006-12-07) 2 .3 Undesirable Phenomena There were intermittent reports on the plight of local pregnant women. The privacy of these mothers-to-be was not respected. Worse still. Apple daily.hospitals have already announced that no further registration for obstetric services would be accepted in the first half year of 2007 due to the excessive workload they encountered due to the influx of Mainland women.4 It was because they knew that those gave birth by surgery (elective caesarean section) were allowed to stay for maximum three nights while those had their babies naturally born (spontaneous vaginal delivery) could only stay one night in the hospital. Extra beds made of canvas were placed inside public wards to cater for the excessive numbers of expectant mothers who were waiting for giving birth. Some were even left in the corridor.
300 5 Public money spent on medical service amounting to $32. 2006. and getting services they had not wholly paid for. Before the imposition of the HK$20. Approximately HK$300 million revenue of Hospital Authority in 2006. 90% was government subvention. prior to this. HKSAR Government. the charge was standardized across all public hospitals at a highly subsidized rate at HK$100 per day for Hong Kong residents and HK$3.Local pregnant women showed concern about deteriorating standards of care and were resentful of outsiders coming in. Hong Kong public medical care is funded mainly by the HKSAR government. which was believed to be the major factor that triggered the implementation of new measures in February 2007.000 obstetric package in September 2005. A group of 30 angry Hong Kong mothers marched to Central Government Office to air their resentment in order to push the Government into taking action on November 19. Sources : Census and Statistics Department.2 billion in 2006 which was around 13% of the overall government expenditure. 3 . jumping queues. the charge for obstetric services was calculated based solely on the number of days of hospitalization. Hong Kong taxpayers generally have the feeling that money they spent went to subsidize Mainland women instead of provide quality medical service to Hong Kong people5 as the obstetric services were provided to everyone at a highly subsidized rate regardless of the service seekers’ nationality.
2004. as the service seekers’ medical history and the health condition of their babies are all unknown to the hospitals. more. especially when the pregnant woman has Viral Hepatitis Type B or Acquired Immune Deficiency Syndrome.pdf) Discussion Paper on ‘Impact of the use of Obstetric Services by Mainland Women on Public Hospital Resources’ by Legislative Council Panel on Health Services. and the babies because illness.gov.hk/yr04-05/english/counmtg/hansard/cm1110ti-translate-e. other patients.000 Mainland women gave birth in Prince of Wales Hospital. 4 .per day for non-Hong Kong residents while the average cost of delivery for a pregnant woman was $12. LC Paper No. 8 In 2006. some of these Mainland women did not settle the bill before they left the hospitals.7 What made the situation even worse was that many of these Mainland pregnant women did not receive any antenatal examination before they came to Hong Kong for giving birth. CB (2) 761/06-07(03). the bad debts of Hospital Authority amounted to $2. Together with the inefficient default payment collecting mechanism.legco. 6 7 Legislative Council Meeting on November 10.000.8 It posed considerable risks to both the mothers-to-be. (2006-12-07) & ‘內地婦港產嬰 5 年升 16 倍’. Besides.6 The influx of Mainland women seeking obstetric What is services imposed significant financial burden to our health care system. this also brought risk to the hospital staffs and other pregnant women staying in the same hospital. Singtao Daily. (http://www. Source : ‘內地婦來港產子要做產前檢查’. (8 January 2007). Mingpao. defects and other possible problems could not be detected before delivery. hospital staff.800 million in 2005/06. (2006-12-07). there were almost 20. More than 70% of them did not receive antenatal examination.000 to $14.
To revive the economy. job opportunities. Before 1997. economic. and catering industries. when Hong Kong was still a British colony. tourism.86 million in 2001. political stability attracted immigrants from Mainland China. and social changes after the handover of sovereignty in 1997.Diagnosis to the Phenomena Economic environment Mainland women giving birth in Hong Kong is a complex issue and cannot be easily explained by one single reason.9 When Hong Kong economy rebounded in 2003. Hong Kong government enacted Immigration Ordinance and imposed strict control over Mainland migrants and visitors. its economic development. The purpose was to control the number of influx of Mainland China to avoid unbearable pressure on the resources of Hong Kong. 5 . After 1997. Hong Kong government agreed to increase the Two-way Permit quota three folds to encourage Mainland visitors traveling Hong Kong. the Severe Acute Respiratory Syndrome (SARS) outbreak seriously hit Hong Kong retail.27 million in 1997 to 4. 03-04. The number of Mainland visitors increased from 2. It is the result of political. The restrictions on Mainland visitors were further relaxed by the 9 Immigration Department Annual Reports 96-97. Hong Kong experienced an economic downturn due to Asian Financial Crisis.
without being part of a tour group) for a maximum of seven days. when the people moving in and out from Hong Kong were governed by Immigration Ordinance Chapter 115 (Cap.e. With the introduction of Basic Law in 1997. 115).. Legal Ambiguity Before 1997. the definition of Hong Kong citizens under Immigration Ordinance was challenged as it was found to be contradictory with Article 24(2)(1) of the Basic Law which provides that Chinese citizens born in Hong Kong Special Administrative Region have the right of abode in Hong Kong.introduction of Individual Visit Scheme in 2003 that allowed Mainlanders to visit Hong Kong in their own capacity (i. Hong Kong residents were defined as Chinese citizen born in Hong Kong if one of his/her parents had settled or had the right of abode in Hong Kong at the time of his/her birth or at any later time. Ambiguity over the definition of Hong Kong residency was cleared on 20 July 2001 when the Court of Final Appeal ruled in the Chong Fung-yuen case that Chinese citizens born in Hong Kong have the right of abode in Hong Kong regardless of the status of their parents. The relaxation of immigration control has paved way for the large influx of Mainland pregnant women coming to Hong Kong for the purpose of giving birth. 6 .
Failure of Charging Policy Another reason for the large influx of Mainland mothers-to-be was the low charge for obstetric services in Hong Kong. They know that their babies. welfare. (2007-02-02). housing benefit and social welfare. The same fee 10 ‘Authority cashes in on pregnancy policy’.10 Some said that these newborn babies would be a solution to our ageing problem while some argued that they might be the heaviest financial burden to Hong Kong society. Health care services in Hong Kong are distributive in nature. and education. Fees and charges for different medical services are standardized across all public hospitals at a highly subsidized rate. residency in Hong Kong. will have free education. Although either hypothesis is anticipation.The decision of Court of Final Appeal gave all babies born to Mainland women in Hong Kong. as Hong Kong citizens. regardless of their citizenship and financial condition. 7 . Many Mainland parents have expressed that they will have their children in care of relatives in Hong Kong and to be educated in Hong Kong. the number of babies born to Mainland women is large enough to have implication on Hong Kong’s planning and policy on population. which is also the main reason for Mainland women coming to Hong Kong for giving birth. would be contemplated. South China Morning Post. Requests from any person. healthcare.
the baby delivery service. Since children born in Hong Kong 8 . seeking payment is made before they left.300 for one-day hospitalization in a public general ward. Before September 2005. Mainland parents could avoid the penalty for having more than one child under One-child policy. further encouraged such free-riding behaviour.000 as penalty. nothing to lose.structures applied to Hong Kong and non-Hong Kong residents alike. obstetric services in Hong Kong have everything to gain. In addition. by giving birth in Hong Kong. The low charge level attracted Mainland women since they could enjoy enormous benefits including better medical care and Hong Kong residency for their children born in Hong Kong. Every extra child will cost the couple around RMB80. many Mainland women did not settle the bill before leaving the hospitals. It stipulates that each couple is only entitled to have one child. there is no policy or system in place to ensure full The ineffective default payment mechanism For Mainland women. obstetric service for Mainland women only costed HK$3. This policy was adopted by Mainland China since late-1970s as a measure to control its population. What is more. Despite the low medical charge. This charge has already included The charge was so low that it could not even cover the cost of delivery.
As services were provided based on medical need regardless of the patients’ or service seekers’ citizenship. Private consultation fees were also revised from fixed standard charges to pre-sent ranges to reflect variations in the complexity of the patients’ clinical conditions and in the expertise that might be required for treatment.are Hong Kong citizens and will not have Mainland Hukou. The whole package charges each service seeker HK$20. citizenship.000. requests from local and Mainland pregnant women were handled in the same manner. Government Actions The ever-increasing number of Mainland mothers giving birth in Hong Kong made the government realize the problem. It is recognized that the obstetric service charge To for non-Hong Kong residents was set too low. which included delivery and three days 2 nights of hospitalization in a public general ward. Each non-Hong Kong pregnant woman giving birth in Hong Kong will be provided with a minimum obstetric package. bring the market to optimum. the Hospital Authority introduced a new charging system as a rational basis for the allocation of resource in September 2005. their parents would not be fined. causing market disequilibrium. 9 .
pdf 12 ‘4 日男嬰 離奇猝死’. and Food Bureau Dr. York Chow. Ambrose Lee. and Mainland China Authorities on the issue. the Bureau came up with some measures to tackle with the problem.200 million. (2006-12-27). the Mainland mothers left with their babies prematurely to evade payment. These acts pose significant risks to both the mothers and babies. the defaulted payment arisen from obstetric services by Mainland women amounted to HK$1. Wenweipo.gov.hk/pdf_e/e47ch05.The alarming figure of bad debt11 also pushed the authority to introduce measures to avoid defaulted payment. 10 . http://www. HKSAR Government.aud. There were intermittent reports that babies died due to inadequate postnatal care as the babies’ mothers left hospitals for avoiding payment. However. After several meetings among the Secretary for Health. The minimum obstetric service package required all non-Hong Kong residents to pay a deposit of $19.12 Noise from the public and the pressure groups formed up by pregnant women had pushed the government in facing the problem in a more active way. Source : ‘Hospital Authority : management of outstanding medical fees’. Welfare. Secretary for Security Mr. they avoided paying deposit by seeking service from accident and emergency (A&E) ward when they approached to deliver.800 upon admission at a public hospital. After delivery. as many Mainland pregnant women know that they would not be denied medical service due to lack of means. Audit Commission. Aims of the measures are to ensure that local pregnant women would be provided with proper and 11 In 2004/2005 financial year.
(eds). (1990). problem of ‘free-riders’. 11 .. Governing the Commons.priority obstetric services through restricting the number of non-local pregnant women giving birth in Hong Kong to a level that can be supported by Hong Kong’s healthcare system. Fairfax.. Va. The Theory of Market Failure : A critical Examination... 14 The presumptions are the summary of reference drawn from OSTROM. Press Release.13 Framework of Study This paper will employ market theories to explain the problem of insufficient public obstetric service in Hong Kong. Cambridge : NewYork. (eds). www. KELLY.M. Advanced in Policy Studies since 1950. Cambridge University Press. W. The following are the major presumptions in the framework14 – i) Public obstetric service is common-pool resources that are non-excludable and subtractive. 2007. The problem of externalities resulted in market inequilibrium and inefficiency. COWen.info.hk. E. T. iii) The problem of externalities can be solved by internalizing the social cost to individual through Pigouvian tax so that the consumer can see 13 ‘New measures on obstetric services and immigration control’ on January 16. ii) Its nature inevitably results in the As human beings are rational and self-interested.gov. New Brunswick and London : Transaction Publishers (1992). they only see the cost imposed on them and neglect the cost imposed on the society as a whole. R. : George Mason University Press and DUNN.
journals and reports and meeting records of Legislative Council. Extensive research on academic Additionally. useful information will be collected from newspaper. and websites. magazines. I will ask the following questions: What makes the public obstetric services become so scarce? Why could the policy adopted in 2005 not solve the problem? Can the new policy implemented in 2007 solve the problem of Finally. Research Questions In this dissertation. 12 . can the policy mark an end to Hong insufficient public obstetric services? Kong people’s anxiety over Mainland women’s utilization of obstetric services? Methodology This paper employs the theoretical frameworks of ‘common pool resource’. iv) One of the greatest challenges to Pigouvian tax is that the government is not able to have perfect information to set the optimal tax level.the real cost of their consumption. literature will be conducted on these theories. ‘externalities’ and ‘Pigouvian tax’ to illustrate the problem of insufficient public obstetric service in Hong Kong in recent years.
the evolution of Hong Kong’s immigration policy on Mainlanders before and after 1997 will be discussed. representatives of enforcement agencies and professionals such as doctors and nurses to seek their views on the feasibility and effectiveness of the new policy. Chapter 3 will explain the Mainland women’s service-seeking behaviour from This chapter will apply the Pigouvian theorem in economic point of view. Dissertation Plan The whole dissertation comprises six chapters. In Chapter 2. 13 .Interviews will be conducted with representatives of interest groups. this chapter will analyze the policy effectiveness and legitimacy by referring to the choice of policy tools and the design of policy. The last chapter will round up the whole dissertation by proposing suggestions on the way forward. The discrepancies between Immigration Ordinance and Basic Law after 1997 will be emphasized to illustrate the reason for the influx of Mainland pregnant women after 2001. This policy will be evaluated in Chapter Instead of evaluating the policy outcome. Chapter 4 is the detailed description of the new policy implemented in February 2007. five by applying Policy Instrument theory. answering the failure of 2005 policy.
Hong Kong’s immigration policies for Mainlanders have aimed at controlling the number of migrants from Mainland China to avoid unbearable pressure on the resources of Hong Kong.16 From 1842 when Hong Kong became a British colony. At present. Rwezaura.CHAPTER TWO HONG KONG’S IMMIGRATION POLICY ON MAINLANDERS Introduction Hong Kong has long been an immigration city. Some treasure political stability while some cherish rapid economic development. Evolution of Hong Kong immigration policy on Mainlanders since 1842 is outlined in Annexure B. 14 . Since the British occupation of the territory in 1842. 16 Ibid.. to now. Immigration Policy on Mainlanders in Colonial Era Hong Kong had no immigration control measures on Mainlanders until 1938 when the 15 CHAN. (eds) Immigration Law in Hong Kong : An Interdisciplinary Study. Hong Kong has been a favorite sanctuary for those looking for a better life. more than half of Hong Kong population is immigrants from Mainland China. Pp.15 People from Mainland China come to Hong Kong for different reasons. J. Hong Kong : Sweet & Maxwell Asia (2004). ‘The Evolution of Immigration Law and Policies : 1842-2003 and Beyond’ in CHAN J. B. 1.
Immigration officers could exercise their discretions in granting permits. Pp. enter or remain in Hong Kong18. the Hong Kong Government realized that the society could not cope with the influx of people from Mainland China in terms of physical. Rwezaura. Hong Kong : Sweet & Maxwell Asia (2004). (eds) Immigration Law in Hong Kong : An Interdisciplinary Study. How an illegal immigrant was to be dealt with was decided by the prevailing executive policies and not by the law. and economic infrastructure.500. The Immigration Control Ordinance of 1949 was enacted which provided that any person not in possession of relevant travel documents. Source : CHAN. with or without conditions. every illegal immigrant could obtain entry permit by reporting to the immigration authorities so that their stay could be regulated. the immigration authority adopted an ‘open door’ policy.000. social. frontier passes or certificates of residence issued under the Ordinance were illegal immigrants and would not be permitted to land. Instead of being repatriated to Mainland.947 in 1931 to over 1. visas or entry permit. Notwithstanding the introduction of the Immigration Control Ordinance. J. B. The United Nation and the United States 17 Growth of Population in Hong Kong 1841-2006. Details at Annexure C. to allow an illegal immigrant to stay in Hong Kong. 1. ‘The Evolution of Immigration Law and Policies : 1842-2003 and Beyond’ in CHAN J. One of the reasons was that Hong Kong economy suffered badly in the fifties after the outbreak of the Korean War in June 1950. 18 Natives of Guangdong Province were exempted from this Ordinance.population grew from 878.17 At the time. 15 ..
intelligent. entered the urban areas and subsequently gained a home with relatives or otherwise found proper 19 CHAN.19 Under this ‘open door’ policy.203. ‘The Evolution of Immigration Law and Policies : 1842-2003 and Beyond’ in CHAN J.700 in 197321. B. 56. in 1973 alone. Rwezaura. in 1974. These refugees were the major force of economic growth at that time which explained why the government adopted such a lenient policy toward illegal immigrants from Mainland China in the fifties and sixties.imposed embargoes on Mainland China and Hong Kong. Pp. political uncertainties pushed refugees from Mainland China who brought to Hong Kong capital and industrial expertise as well as a pool of skilled. the figure was quite alarming. about 60. 20 Ibid. Census and Statistics Department. 16 . but all others who evaded immediate capture. (eds) Immigration Law in Hong Kong : An Interdisciplinary Study. and industrious labour. It pushed the Hong Kong Government to impose a ‘reached-base’ policy Under this policy. illegal immigrants who were arrested in the border region or in Hong Kong territorial waters during their attempt to enter Hong Kong would be repatriated. 21 Hong Kong Population Projection 1971-1991.000 Chinese persons entered Hong Kong illegally between 1962 and 1972 and were subsequently permitted to stay. HKSAR Government. 20 When comparing with the total population of 4. J. 6-9.. At the same time. Hong Kong : Sweet & Maxwell Asia (2004).000 illegal immigrants arrived from the Mainland. Trading of Hong Kong almost came to a standstill. However.
the number of Mainlander arrested on arrival and repatriated was 89. Pp. 24 The number of legal immigrants from Mainland China dropped from 107. It was also a sensitive political matter to have an agreement on the quota.24 All illegal immigrants from Mainland China were to be Entry to Hong Kong for Settlement Since the abolishment of the ‘reach-base’ policy in 1980.22 In 1979. Hong Kong : Sweet & Maxwell Asia (2004). However.700. B. Some condemned that this policy positively encouraged illegal immigrants from Mainland and led to an influx of illegal immigrants who arrived and reached base..500 in 1980. the first year of the abolishment of ‘reach-based’ policy. the only legal way for people from Mainland China to come to Hong Kong for settlement was entry under One-way Permit (OWP) scheme.23 This ‘reached-base’ policy was thus abolished in 1980. 12-13. Ibid Pp. OWP scheme is a quota system introduced in 1950 with maintaining a rough balance between the inflow and outflow of people as its major objective.900 while those evaded capture and remained in Hong Kong was 107. 12. J. Rwezaura. removed.700 in 1979 to 69. 17 .600 (1977) to 28. five years after the implementation of ‘reach-base’ policy. 23 Illegal immigrants from Mainland who successfully evaded capture and remained in Hong Kong increased from 6.accommodation would be given permission to stay in Hong Kong.700 (1979). ‘The Evolution of Immigration Law and Policies : 1842-2003 and Beyond’ in CHAN J. (eds) Immigration Law in Hong Kong : An Interdisciplinary Study. as this might 22 CHAN. the introduction of quota was opposed by the Mainland authority as ‘unreasonable and unfriendly act towards the PRC and its people’.100 (1978) to 107.
the number of legal migrants who It reached a peak came to Hong Kong by way of an OWP varied from time to time. Since then the daily limit remained unchanged. 15-16. Therefore. Hong Kong : Sweet & Maxwell Asia (2004). British and Chinese governments reached an agreement on the daily limit of the number of legal immigrant to 150 per day in 1980. which is the issuing authority of OWP’s. the Mainland authority. the quota was not strictly enforced. (eds) Immigration Law in Hong Kong : An Interdisciplinary Study. The authority reduced the limit to 75 per day in 1983 while it increased to 105 in 1993 to facilitate the admission of a large number of long-separated spouses and children born to Hong Kong citizens. It resulted in 67. 18 . still changed the daily limit over time. A compromise would be that the Director of Immigration always gave permission to land to whoever was issued an OWP.constitute a tacit recognition on the part of the Chinese government that Hong Kong was not part of China. Rwezaura.25 Entry to Hong Kong for Visit The restrictions over Mainland visitors were strict in colonial era. Mainlanders who wish to make private visit to Hong Kong had to apply for a Two-way permit (TWP) 25 CHAN. J. the quota increased to 150 per day.495 legal immigrants from Mainland China Although the in one single year.. of 310 per day in 1978. In 1995. which was almost 250% of the figure in 1977. B. Pp. ‘The Evolution of Immigration Law and Policies : 1842-2003 and Beyond’ in CHAN J. Indeed.
19 . The daily limit increased to 1. For Group Visit. requirements upon application. spouse’s parents and siblings. depart together as a group. the definition of ‘close relative’ confined to parents. They must arrive and There was also daily quota imposed on the Group visit endorsement.27 Mainland people coming to Hong Kong for visits before 1997 were not as free as Hong Kong people going to Mainland China for visits were. spouse. Relative Visit endorsement was issued for those who went to Hong Kong for managing properties or business or visiting close relatives who were Hong Kong permanent residents. 一國兩制研究中心. certificate of marriage.3 persons for the whole of Mainland China. 內地人士非移民簽證來港的政策檢討及建議. visitors had to join tours organized by one of the three recognized and approved Mainland tour operators.142 in 1998.from Mainland Public Security Bureau offices before entry. Pp 6-9. including copies of Hong Kong Identity Card. or more. Shanbo (2002). 26 Before 1997. TWP scheme was Before 1997. Endorsement would only be issued to those who had relatives residing in Hong Kong. though this was still inadequate to cope with the demand. upon application. The applicant must produce proof of business and properties in Hong Kong or proof of close relatives26 living in Hong Kong. Each had strict ‘Tanqing’ (Relative visit) and ‘Tuandui Luyou’ (Group visit). implemented in 1950. 27 SHAO. there were only two types of endorsements. It was hard to believe that the average daily quota for Group visit was 8.
there was no significant influx of Mainlanders.Immigration Policy on Mainlanders after 1997 Immediately after the change of sovereign. 內地人士非移民簽證來港的政策檢討及建議. reason was that the China Government did not want chaos at the time of handover and sought stability. all these Asian currencies depreciated with Traveling to other Asian countries became much respect to the Hong Kong dollar. the outbreak of the Asian Until the financial crisis began with the depreciation of the Thai baht in July 1997.26 million in 1997. political stability faded away as the issue of concern as the economy became the major focus. either for settlement or for visit. The 150 daily quotas for OWP still Number of Mainland visitors to The major applied and the issue of TWP was not released.75.28 It was ironic that. 20 . Two Systems’ arrangement went off to an auspicious start. Since Hong Kong dollar was linked to the US dollar. Quite unexpectedly. 一國兩制研究中心. What many Hong Kong people and international observers feared about intervention by Chinese authorities did not happen. Pp 20. The ‘One Country. remained steady at 7. after the changeover of sovereignty in July 1997. 28 SHAO. Shanbo (2002). it As a result. Hong Kong decreased from 2. end of January 1998. a number of Asian currencies had depreciated substantially with respect to the US dollar.29 million in 1996 to 2.
cheaper than to Hong Kong after their currency depreciation. The requirements for Relative 29 LIU. 21 . most of the China’s investment took the form of factories on the ground rather than securities. S. who previously were required to obtain a visa upon arrival at Hong Kong. Pak-wai (1998). In 1998.32 To revive the economy.31 The Chinese economy was hardly affected by the financial crisis as it continued to grow at 8. 31 With all of its foreign investment took the form of factories on the ground instead of securities.8% in 1997 and 7. ‘The Impact of SARS on Greater China Economies’ in Wong. RMB’s non-convertibility protected its value from currency speculators. SARS Epidemic.29 Domestic consumption shrank and the economy contracted. Liang. 13. J (eds). 32 Wong. Richard. Unlike other Asian countries. which allowed visitors on business trip. Singapore : World Scientific Publishing Company. Hong Kong Institute of Asia-Pacific Studies. RMB's non-convertibility protected its value from currency speculators. 62-83. Pp. China insulated itself from rapid capital flight. Asian Economic Papers 3:1 (Winter 2004). R. China was less affected by the financial crisis.. Economic Impact of SARS : The case of Hong Kong. (2004) Pp.8% in 1998. In the first half of 1998. Hong Kong government agreed to have the restrictions on the issue of TWP relaxed. China Government introduced ‘Shangwu’ (Business visit) endorsement.30 When compared with Hong Kong. 18 30 SIU. Mainland China was less affected by the Financial Crisis.. J. Chan. which insulated the country from rapid out flowing of assets and money and sharp drop in the exchange rate after the financial crisis. the number of visitor arrivals declined sharply by 21% as compared to the first half of 1997. The Asian Financial Crisis and After Problems and Challenges for the Hong Kong Economy. Hong Kong’s unemployment rate hit record levels exceeding 7% by the end of 2002. Alan & WONG. pp.
Hong Kong experienced another crisis –Severe Acute Respiratory Syndrome (SARS). The daily quota for Group visit endorsement increased from 1. 36 Real GDP in Hong Kong grew at 3. 2003.67 million in 1998 to 6. 33 At present. Shanbo (2002). his brother-in-law to Kwong Wah Hospital on February 13. Economic Impact of SARS : The case of Hong Kong. 62-83. 8. The relaxation in TWP permit requirements greatly attracted tourists from Mainland China. The number of Mainland visitors to Hong Kong increased from 2. Sources : SIU. 34 35 Tourism Development Board. Pp.34 Revenue from tourism-related activities increased from 142 millions in 1998 to 287 million in 2002. 22 .Visit endorsement were released in 2000. He stayed in a hotel in Kowloon for one night in February.35 When economy started to recover again 36 .142 in 1997 to 1. also increased from 3 before 1997 to 63 in 2002.82 million in 2002. All tour operators were monitored by the China Tourism Association. worked. Alan & WONG. which undertook the application of Group visit endorsement. pp. HKSAR Government. Asian Economic Papers 3:1 (Winter 2004). 一國兩制研究中心. 33 SHAO. He sought medical treatment in Hong Kong and was admitted Not soon after. there are in total 99 tour operators in Mainland China that can apply Group Visit TWP.500 in 2000. Richard. which allowed Mainlanders to visit their relatives who lived. and studied in Hong Kong. The number of tour operators in Mainland China. Ibid.1% in the fourth quarter of 2002. 內地人士非移民簽證來港的政策檢討及建議. A professor from Guangdong came to Hong Kong for a relative’s wedding.4% in the third quarter of 2002 and at 5.
On April 2. admitted to Ward 8A of Prince of Wales Hospital (PWH) and brought the index case for Hong Kong’s first outbreak in PWH. 1451 were discharged while 304 died of the disease.and 16 other people. 2003. HKSAR Government.gov.htm. The SARS epidemic reached its peak on March 30. 2003.gov. 2003 when the government issued an order to isolate Block E of Amoy Garden after 213 residents of Amoy Garden were admitted to hospital for suspected and confirmed SARS with half of the cases were from block E. were admitted. Department of Health.hk/english/reports/reports/reports_fullrpt. with Hong Kong’s April arrivals dropping by almost 65% compared with 2002. total 1755 people were infected with SARS. Department of Health.info. On February 22. the World Health organization (WHO) issued an advisory against non-essential travel to Hong Kong and Guangdong Province.39 Fearing the disease might spread to the community at large. 38 Hong Kong Tourism Board Annual Report 2003-2004. Another patient. 2003. who stayed in the same hotel with the professor. 39 SARS. Hong Kong people refrained from many consumption activities outside their 37 SARS Expert Committee Report : From Experience to Action.37 Visitor numbers fell throughout the Asia-Pacific region. Eleven healthcare staff of PWH working in Ward 8A left on sick leave on March 10. HK Government http://www.html. The number of medical staff who had infected with SARS through contact with this patient increased to 139. and those of May by almost 68%.38 By the end of the epidemic. the Guangdong professor was certified death and was later confirmed to have died of SARS.hk/info/sars/e_sars2003. who visited an acquaintance staying on the same floor of the hotel during the critical day in February.sars-expertcom. 23 . http://www.
Hong Kong SAR Government. The drop in demand put further pressure on the price level and worsened the unemployment problem. The Individual Visit Scheme has brought a significant increase in the number of Mainland visitors to Hong Kong from 8. it was opened only to residents of Dongguan.40 To bring the Hong Kong economy back to life.5 million in 2003 to 12.homes.234 million in 2003 to 91. and Foshan in Guangdong Province. HKSAR Government. Individual visitors from the Mainland were permitted to remain in Hong Kong for a period of not more than 7 days upon each entry. the scheme extended progressively. In the past three and a half years. the Chinese Government further released the issue of TWP and implemented the Individual Visit Scheme. 40 Unemployment rate increased from 7. When this scheme was introduced in July 2003.2 million in 2004 which brought an increase in inbound tourism revenue from 70.849 million in 2004. Mainlanders might go to Hong Kong as individual visitors. The number of visitors from Mainland China from 1997 to 2006 is shown in Annexure E.5% in March 2003 to the highest point of 8. Zhongshan. Source : Census and Statistics Department. 24 . 41 Tourism Board Highlights 2004.7% in July 2003. Jiangmen.41 The Individual Visit Scheme was successful in reviving Hong Kong economy while it also paved way for Mainland pregnant women to come to Hong Kong for giving birth. and now covers Guangdong province and 28 other cities (Refer to Map at Annexure D).
Two Systems".42 Immigration Ordinance The definition of ‘Hong Kong citizen’ was stipulated in Immigration Ordinance Cap. a child born in Hong Kong acquired the status of a British Dependent Territories (Hong Kong) 42 43 The Basic Law of The Hong Kong Special Administrative Region of The People’s Republic of China. Most of the Hong Kong people fell largely into the category of British Dependent Territories Citizens. The Basic Law of the Hong Kong Special Administrative Region (The Basic Law) was adopted on 4 April 1990 by the Seventh National People's Congress (NPC) of the PRC. 115. the implementation of the British Nationality Act 198143. The Joint Declaration provides that these basic policies shall be stipulated in a Basic Law of the HKSAR. 25 . The British Nationality Act 1981 was an Act of Parliament passed by the British Parliament concerning British nationality. Country. The Act reclassified Citizenship of the United Kingdom and Colonies into three categories relating to the right of abode in United Kingdom : British citizens who had the right of abode in the UK. British Dependent Territories Citizens who enjoyed a right of abode in the Dependent Territories and British Overseas Citizens who enjoy right of abode nowhere in the whole. It came into effect on 1 July 1997. Before 1997.Contradiction between Basic Law and Immigration Ordinance The Sino-British Joint Declaration on the Question of Hong Kong (The Joint Declaration) was signed between the Chinese and British Governments on 19 December 1984. the socialist system and policies shall not be practiced in the Hong Kong Special Administrative Region (HKSAR) and Hong Kong's previous capitalist system and life-style shall remain unchanged for 50 years. The Joint Declaration sets out the basic policies of the People's Under the principle of "One Republic of China (PRC) regarding Hong Kong.
26 44 . While its meaning remained the same which required that for a Chinese citizen born in Hong Kong to be a permanent resident. It was the common understanding of the Chinese and British experts under the Sino-British Joint Liaison Group that similar arrangement would apply after 1997 and no formal agreement was made before the reunification.citizen if one of his or her parents had the same status or was settled in the city at the time of their birth. Basic Law However. 1(5) of Schedule 1 of Immigration Ordinance Cap. 115 as ‘A person is settled in Hong Kong if he is ordinarily resident in Hong Kong. and he is not subject to any limit of stay in Hong Kong. this qualifying requirement sated in paragraph 2(a) of Schedule 1 of Immigration Ordinance does not exist in Article 24 of Basic Law. 115. a Hong Kong permanent resident enjoys the right of abode in Hong Kong which are the right to (a) land in Hong Kong. 115. (c) not to have a deportation order made against him and (d) not to have a removal order made against him. 115 was slightly amended upon the change of sovereign in 1997. For the purpose of reunification. 45 According to s. (b) not to have imposed upon him any condition of stay in Hong Kong. 2A of Immigration Ordinance Cap. permanent identity cards which state their right of abode – The term ‘settled’ is defined by Para. one of his parents must have been settled44 or had the right of abode45 in Hong Kong at the time of his birth or at any later time. in accordance with the laws of the Region. Article 24 of Basic Law states that the following categories of people shall have the right of abode in Hong Kong and shall be qualified to obtain. and any condition of stay that is imposed shall have no effect. This provision was stated clearly in Schedule 1 of Immigration Ordinance Cap. Schedule 1 of Immigration Ordinance Cap.
who. 27 . had the right of abode in Hong Kong only. ii) Chinese citizens who have ordinarily resided in Hong Kong for a continuous period of not less than seven years before or after the establishment of the Hong Kong Special Administrative Region. and vi) Persons other than those residents listed in categories (1) to (5).i) Chinese citizens born in Hong Kong before or after the establishment of the Hong Kong Special Administrative Region. before the establishment of the Hong Kong Special Administrative Region. have ordinarily resided in Hong Kong for a continuous period of not less than seven years and have taken Hong Kong as their place of permanent residence before or after the establishment of the Hong Kong Special Administrative Region. iv) Persons not of Chinese nationality who have entered Hong Kong with valid travel documents. iii) Persons of Chinese nationality born outside Hong Kong of those residents listed in categories (1) and (2). v) Persons under 21 years of age born in Hong Kong of those residents listed in category (4) before or after the establishment of the Hong Kong Special Administrative Region.
Chong’s grandfather lodged a claim about Chong's status with the Director of Immigration. They were not residents of Hong Kong. the Director of Immigration The Contradictions between Basic Law and the qualifying requirements provided in the Immigration Ordinance brought a numbers of judicial reviews where decisions and authority of the Director of Immigration Department were challenged. CHONG Fung-yuen v. The Director did not accept CHONG Fung-yuen as permanent resident of Hong Kong. the mother gave birth to CHONG Fung-yuen on 29 September 1997.More importantly. permanent or otherwise. That was in November 1997. CHONG Fung-yuen case was a classic case arguing the legal provision on the residency of Hong Kong born child to Mainland parents. and did not accept that he 28 . Article 11 of Basic Law provides that no law enacted by the legislature of the Hong Kong Special Administrative Region shall contravene the Basic Law. They were arrested and repatriated while CHONG Fung-yuen stayed in Hong Kong with his grandfather who was a Hong Kong citizen. Shortly after the parents arrived in Hong Kong. CHONG Fung-yuen’s parents were Mainlanders who came to Hong Kong with two-way permits on a visit in early September 1997. The authority of Immigration Ordinance was seriously challenged.
The judged state that – the words in paragraph 2(a) of Schedule 1 to the Immigration (Amendment) Ordinance enacted on 1 July 1997 : ‘if his father and mother was settled or had the right of abode in Hong Kong at the time of the birth of the person or at any later time’ were in my judgment incompatible with. The Court of First Instance ruled that the wordings in Article 24(2) (1) of the Basic Law are clear and self-explanatory enough to confer the status of permanent residents on Chinese citizens who have been born in Hong Kong. HACL 69/1999 29 . and contravene art.has the right of abode in Hong Kong by referring to the provision stated in Para 2(a) of Schedule 1 of Immigration Ordinance. the Director of Immigration.46 46 CHONG FUNG-YUEN v.24(2)(1) of the Basic Law. Chong’s grandfather applied for a judicial review against the Director’s decision in 1999. They have therefore no effect to limit the right of abode of those Chinese citizens born within Hong Kong.
there were totally 1991 Chinese citizens born in Hong Kong whose parents neither had the right of abode in Hong Kong nor Hong Kong residents.Besides. 2001. the judges of the case had reviewed the numbers of children born in Hong Kong between July 1. the number of such births in Hong Kong has risen from 709 in 2000 to 9273 in 2005. 47 Between July 1. 2001. (2006-12-04) 30 . The lack of foresight of our judges brought about today’s plight. whose parents neither had the right of abode nor lived in Hong Kong at the time of birth.) 48 ‘The Hordes at our gate’ by Regina Ip. they concluded that such judgment posed no ‘significant risk’ to the city and decided that anyone born in Hong Kong is Hong Kong resident regardless of his or her parents’ residency48. 1997 and January 31. a 13-fold increase. 62 of 2000. South China Morning Post. The decision of Court of Final Appeal has tremendous implication on Hong Kong population policy. Following the Court’s judgment. CACV No. (CHONG Fung-yuen v. 1997 to January 31. Director of Immigration lodged an appeal to the Court of Appeal and Court of Final Appeal and were both dismissed. Once the floodgate was open. the Director of Immigration.47 Based on the survey of 43 months. Hong Kong medical and health care and social welfare services became the big pull for Mainland mothers.
once access is gained and consumption or use occurs. we basically ask two questions : firstly. By referring to the public obstetric service as a common-pool resource. to restrict someone’s access to the resources and becomes unavailable for subsequent consumption once it is open for access. problems of collective action and problem of externalities can be used to explain the service-seeking behaviour of Mainland pregnant women.CHAPTER THREE DIAGNOSIS OF THE PROBLEM FROM AN ECNONOMIC APPROACH Introduction In this chapter. the insufficient public obstetric service for local women will be diagnosed from an economic perspective. For goods which is very difficult. does the good or service remain available for subsequent consumption or use by someone else. The content and effectiveness of government reactions in 2005 will be analyzed through Pigou’s theorem of government intervention as a solution to the problem of externality. is it possible to restrict someone’s access to that good or service and the second. if not impossible. we can 31 . Common Pool Resources When categorizing a good or service.
Problem of Collective Actions Standard analysis in modern resource economics concludes that when common-pool resources are open to people for consumption. Cambridge: Cambridge University Press. he used behaviour of As human beings are rational and If rational herders to illustrate the phenomena. every herder can gain access to the same piece of land.N. These resources are so large Furthermore. Governing the Commons : The evolution of institutions for collective action.. 32 . (2001). Public policy analysis : a political economy approach. they tend to add more and more animals as they receive the direct benefit of their own animals and bear only a share of the costs resulting from overgrazing. (1990). The individual is likely to neglect the impact of overgrazing as everyone thinks chiefly of his own. and fishery grounds49. E. there will be one day when the resources be used up if open for consumption without proper management or control. self-interested. pastures. K. New York : Houghton Mifflin. (1990). E.categorize it as common-pool resource. Pp 2. hardly at all of common interest.51 49 Ostrom. the problem of collective action is common. 5 51 Ostrom. 50 Brickers. these that it is impossible or too costly to restrict someone’s access. pp. Cambridge: Cambridge University Press. The most typical examples of common-pool resources are forests. Pp 30. people do things to advance their own goals and objectives50. In Garrett Hardin’s ‘Tragedy of the Commons’. Boston . Governing the Commons : the evolution of institutions for collective action. resources are exhaustible.
Another scholar Robert Axelrod suggested that the ‘Tragedy of Commons’ could be avoided by repeated interactions and cooperation among individuals. The rationale
behind this is that individual will cooperate if they believe that gains from cooperation over time outweigh the loss in short-term benefits of not doing so. However, due to
individuals’ inability to trust one another, they fail to cooperate and end up competing with each other. This theory is called prisoner’s dilemma, which is a common
representation of the failure of self-interested individuals to cooperate due to lack of trust.
Mancur Olson in The Logic of Collective Action also suggested those human beings are rational and self-interested. Unless the number of individuals is small, or unless
there is coercion or some other special device to make individuals act towards their common interest, rational, self-interested individuals will not act to achieve their common or group interest.52 best interest. Instead, they will behave in a way that brings them the
Ostrom, E, ‘Policy Analysis of collective Action and Self-Governance’ in Dunn W.N. & Kelly, R.M (eds) Advances in Policy Studies Since 1950, New Brunswick (USA) and London (UK) : Transaction Publics (1992), Pp 89-90. 33
The above three theories are closely related. At the heart of each of these models is the free rider problem. Whenever one person cannot be excluded from the benefits
that others provide, each person is motivated not to contribute to the joint effort and to obtain benefit without paying. Since individuals are rational and self-interested, they tend to allow others to pay for the goods so that they may ‘free ride’. participants choose to free ride, the collective benefit is not produced. If all
On the other
hand, some may provide while others free ride, leading to a less than optimal level of provision of collective benefit. The temptation to free ride, however, may dominate
the decision process and thus all end up where no one wanted to be. These models are extremely useful for explaining how perfectly rational individuals can produced, under some circumstances, outcomes that are not ‘rational’ when viewed form the perspective of all of those involved.53
Externalities The irrational outcome usually appears in the form of inefficiency due to negative externalities. Figure 154 shows the effects of a negative externality. The marginal
benefit curve showing the maximum value that one is willing to pay for successive
Ostrom, E, ‘Policy Analysis of collective Action and Self-Governance’ in Dunn W.N. & Kelly, R.M (eds) Advances in Policy Studies Since 1950, New Brunswick (USA) and London (UK) : Transaction Publics (1992), Pp 90. 54 Dahlman. C.J., ‘The Problem of Externality’ in Cowen T. (eds) The Theory of Market Failure, Virginia : George Mason University Press (1988). Pp 209-234. 34
units of goods while the marginal social cost curve representing the maximum values that one is willing to forgo for the production of successive unit of goods. In a
perfectly competitive market, the efficient equilibrium is at the point of intersection of the supply and demand curves, where marginal social cost equals to marginal social benefit. The latter reflects the idea that the marginal social benefits should equal the marginal social cost, that is the production or consumption should be increased only when the marginal social benefit exceeds the marginal social cost.
However, there are situations where individual decisions are not based upon full account of true costs and true benefits. If the consumers or producers only take into
account their own private cost, they will end up at price Pp and quantity QP, instead of the more efficient price Ps and Qs. The result is that a free market is inefficient since
at the quantity Qp, the social benefit is less than the social cost, so society as a whole would be better off if the goods between Qp and Qs had not been produced or consumed. The problem is that people are buying and consuming excessively. The most typical example of externality is the problem of pollution. Producers only see
their private costs of production such as input of materials, labour cost, rent of factory, while fail to appreciate the real cost or the social cost to others such as pollutions arisen from their production and the impact of others’ health. As the producers
N. Modern resource economics analysis also concludes that where number of users have access to a common-pool resource. 86 36 . R. Pp. ‘Policy Analysis of collective Action and Self-Governance’ in Dunn W.neglect these externalities. New Brunswick (USA) and London (UK) : Transaction Publics (1992). E. they tend to produce more than market optimum and induce loss to the society as a whole.M (eds) Advances in Policy Studies Since 1950.55 55 Ostrom. & Kelly. total resource units withdrawn from the resource will be greater than the optimal economic level of withdrawal.
(Figure 2 refers56) 56 Dahlman. (eds) The Theory of Market Failure.One of the most frequently cited solutions to externality is government intervention by way of user charges or tax. Pp 209-234.. Virginia : George Mason University Press (1988). ‘The Problem of Externality’ in Cowen T. goods or services consumed or produced.J. which was suggested by Pigou in Economics of Welfare in 1921. 37 . C. He stated that it is desirable to make the producers or consumers take By imposing charges or tax for every unit of responsibility for the externalities. the real cost is internalized to the producers or consumers so as to resume the market optimum.
it is in reality impossible to restrict one’s access to medical care.. the transaction costs for formulating regulation. medical services that are provided by public hospitals can be categorized as common-pool resources that are non-excludable and subtractive.J. However. He criticized that government is not capable of gathering perfect information to set an optimal level of charge or tax to bring marginal private cost equal to marginal social cost. it is the Hospital Authority’s principle not to deny medical care due to 57 Dahlman. Additionally. He further suggested that when there are no costs of transacting.57 Public Obstetric Service in Hong Kong In Hong Kong. all externalities would be eliminated. 38 . which makes medical service a private good. In Hong Kong. ‘The Problem of Externality’ in Cowen T. Pp 209-234. (eds) The Theory of Market Failure. as costless transaction opportunities will allow suitable modification of translations behaviour so that all undesirable side effects are properly internalized. C. Virginia : George Mason University Press (1988). imposition of tax and monitoring are too high.Pigouvian theorem ‘The Pigouvian Tax’ was criticized by Ronald Coase to be inefficient in solving public problem. Non-excludable means that it is impossible to prevent relevant people from using the resources and subtractive means that consumption by a person will impose cost on others. Some may argue that user charge excludes those who cannot afford the payment from accessing the medical services.
thereby imposing costs on other patients. ward. The government A pregnant woman about to give birth was turned away from three hospitals and a clinic in Kunming because she only had 900 yuan. medical services will be provided to any person in Hong Kong who is in need regardless of their ability to pay. Obstetric service before September 2005 calculated on the number of day of hospitalization. among the HK$300 million revenue of Hospital Authority. bed. Hong Kong residents only had to pay HK$100 per day for admission to public hospital for giving birth.lack of means. South China Morning Post. Additionally Mainland mother are patients requiring addition drugs. over 70% of the total government revenue was from tax. medical attention from doctors and nurse. are forced to pay more and give birth in private hospitals when the limit in public hospitals is reached. The ethical concern makes public medical service non-excludable in nature.60 Patients seeking medical service only have to pay at a rate. 2007-04-03. ‘Hospitals slam door on pregnant woman’.300 per day. Pregnant women. 59 In 2005/2006 financial year. HK$263 million was from government subvention. who now received less attention from nurse and doctors and less space in the same ward. 60 In 2005/2006 financial year. who do not manage to reserve a place in public hospital or who want to have better medical care. Unlike Mainland China58. Public medical resource is common-pool resource because it is also subtractive. 39 . Hong Kong public medical services are funded mainly by the government59 through revenue from taxes and sale of land. which is highly subsidized by government. 58 Non-Hong Kong residents paid HK$3. as human lives are paramount.e. 90% i.
and better postnatal care. 2004. They focus on their private costs and benefits while neglecting the costs for the Hong Kong society by consumption of medical care. Cost of giving birth in Hong Kong When deciding whether to give birth in Hong Kong or in Mainland.000 to over HK$100.gov.hk/yr04-05/english/counmtg/hansard/cm1110ti-translate-e. The charge for obstetric services in private It ranges from HK$15. in private or in public hospital. Mainland mothers choose the option that benefits them most. 61 Legislative Council Meeting on November 10. Mainland women evaluate the costs and benefits based on their knowledge.subsidized 97% and 75% respectively as the cost of delivery for each pregnant woman is estimated to be HK$12. hospitals is much higher. As utility maximizers. service charges will choose private hospitals that provide better medical treatment.000 (Service Those who can afford the higher charges of seven private hospitals at Annexure F).000. (http://www.pdf) 40 . a more comfortable stay.61 Alternative to public medical service is private medical service provided by seven private hospitals in Hong Kong.000 to HK$14.legco.
Many of these Mainland mothers-to-be come to Hong Kong with two-way permit under Individual Visit Scheme.62 They come to Hong Kong mainly by train.300 before September 2005. For those who have no relative in Hong Kong. which were only HK$3.htm 41 . The most important one would be forgoing ‘hukou’. The transportation cost is rather limited.I) Short-term costs Giving birth in Hong Kong involves short-term costs and long-term costs to Mainlanders. II) Long-term costs Giving birth in Hong Kong is not without long-term cost. Short-term costs include obstetric service charges.com/wlgat/gdgry/index. Mainland pregnant women come from Guongdong province. Hukou system was implemented by Mainland China government in 1955 as a measure to guard big cities 62 63 ‘特首：需要新醫院 便建新醫院 與公安部研究孕婦來港產子問題’.63 However. The application fee for a TWP together with a single entry endorsement costs RMB120.gdcrj. The cost of lodging ranges from hundreds to thousands. Majority of It depends on the type of accommodation chosen by the Mainlanders. Mingpao. in Mainland China. travel during pregnancy involves risk to the mothers and babies that should also be counted as costs. i.e. http://www. citizenship. they have to pay lodging. Source : Website of Division of Exit and Entry Administration Department of Public Security of Guangdong Province. (2006-12-29) Application fee fro a two-way permit cost RMB120 for a single entry while cost RMB140 for double entries.
marry. Hukou registration provides the principal basis for establishing identity. (1994) The Origins and Social Consequences of China’s Hukou System. The China Quarterly. one cannot establish eligibility for food. Unlike Hong Kong.65 64 Rapid economic development in Mainland China brought significant rural-urban migration. 65 Deborah Davis (1989) Chinese Social Welfare : Policies and Outcomes. or shelter. there are still differentiations.6% of the total population in 1949 to 14. Within both urban and rural spheres.6 million.64 Under Hukou system.against influx of rural population. or enlist in the army. China’s urban population increased from 10. and proof of official status. Without registration. clothing.6% in 1956. go to school. 42 . The state reserves its resources disproportionately for those Benefits allocated to urban areas are privileged over classified as urban population. Children of state official and military officers attend elite schools with small classes while those of workers in urban area go to neighborhood schools and the parents pay 5% of their income for tuition plus a range of miscellaneous fees. every Mainland China citizen is required to register to a Public Security Bureau. with a net gain of 34. their counterparts in countryside. obtain employment. for example in the allocation of social services by job status. The China Quarterly. citizenship. eligibility for the above benefits in Mainland is not standardized across the country. Tiejun Cheng and Mark Selden.
67 66 ‘Four modernizations’ was fundamental part of Deng Xiaoping’s economic reform in China in late 1970s. the Chinese leader at that time. Deng Xiaoping. and to realize the four modernizations66. Four modernization included modernization of agriculture. China’s Populations : Problems. In 1954 when the first census survey in China revealed that China’s population was over 600 million and was growing by 2 percent yearly. As a result. With the implementation of economic reform in late 1970s. 43 . (1999). national defence and science and technology. 87-94. Brookfield. It was also the first time that family planning was confirmed legally and became one of the fundamental duties of all citizens. the Health Ministry issued instruction to all government organizations to provide guidance to people on the concept of birth control. Vt.. 67 WANG. Pp. In 1978. Gabe T. Central Government officials started doubting their traditional beliefs that having large family was a good thing. : Ashgate. majority of these Mainland pregnant women regard hukou as a push instead of a pull of coming to Hong Kong for giving birth because they can flee from paying one-child policy penalty by having baby in Hong Kong. industry. pointed out that strict adherence to population control policies was the only way out of poverty. Thoughts and Policies. the Fifth National Peoples’ Congress ratified the new constitution. Aldershot .Benefits of giving birth in Hong Kong I) Fleeing from One-child Policy Penalty However. which explicitly stipulated that the state advocated family planning.
and resolutely prevent the third child. Mainland and paying the penalty will not guarantee social services especially for those live in rural area and /or without state employment. Gabe T. Aldershot . a family in Guangdong who has their second child will be fined for around RMB80. every Mainland couple is only entitled to have one child. Thoughts and Policies.300 to give birth in Hong Kong. it must strictly control the second birth. The Family Planning Office claims that the rationales behind is first.000..The population Control Policy in late-1970s included four parts. (1999). However. will be a fine for having an extra child. There The penalty varies from city to city. entitlement to social services Having a Hukou in depends largely on the type of Hukou and social status.000 to the government. to make people think clearly before having children and second. from household to household. Vt.which advocates that each couple has only one child. Mainlanders come to Hong Kong for giving birth. : Ashgate. One is to reduce the number of children-. Generally speaking. 95.68 Under the one-child policy. as a financial support for the government to provide education and other welfares for their children. Brookfield. China’s Populations : Problems. Mainlanders can evade from making the penalty of RMB80. It explains why so many 68 WANG. By paying just HK$3. 44 . Pp.
Furthermore. medical services are provided only They follow strictly to this rule. in Mainland. Mainlanders.II) Advanced Medical Care Further. public housing 45 . when full payment is made upon admission. While in Hong Kong. Many Mainland mothers cherish the better living environment and welfare for their children and thus try every mean to give birth in Hong Kong. the major drive for Mainlanders giving birth in Hong Kong is the permanent residency for their children born in Hong Kong. This is also the method used by many Mainland women to flee from The whole system attracts making payment in Hong Kong public hospitals. medical care and technology in Hong Kong is much more advanced than that in Mainland China. as they know that they can obtain better medical service without paying a penny in Hong Kong. III) Hong Kong Residency However. They are attracted by the nine-year free education. the service seeker can easily avoid paying deposit or can make off without payment by approaching A&E ward and seeking service in the last minute. Especially after the landmark Chong Fung-yuen case in 2001. it became clear that everyone born in Hong Kong would be Hong Kong citizen. Reports on denying medical treatment due to lack of means is common in Mainland China.
public medical care. With only limited cost. medical resources are subtractive in nature. Besides. The service-seeking behaviour of Mainlanders has reduced the frequency and quality of prenatal and postnatal checks entitled to all local mothers-to-be. Saturation of public hospitals forced local expecting mothers to give birth in private hospitals. Those managing to get a place in public hospitals are forced to stay in a 46 . The negative externalities associated are not incorporated in the cost function of these Mainland mothers. That makes Hong Kong quite attractive to Mainlanders. but appears as costs to others in the society. As mentioned before. different sorts of allowances such as Comprehensive Social Assistance Allowance and more recently the Pre-primary Education Voucher Scheme. Externalities What these Mainland mothers cannot see are costs imposed on the society upon their consumption of medical care in Hong Kong. the large influx of Mainlanders has placed significant pressure on the Hong Kong medical resources. The cost of delivery ranges from HK$12.000 to HK$14. The difference between the charge level and the cost are borne by Hong Kong taxpayers.benefits.000. their children can enjoy disproportionately greater benefits provided by the Hong Kong government. consumption by one would impose cost to another.
Especially after 2005. Not all of these costs were recognized by the Mainlanders. whose husbands are also Mainlanders. medical care. This discrepancy between the marginal private costs and marginal social costs of seeking obstetric services by Mainland mothers induces a loss in the overall benefit of such consumption for the whole society. Individual rational decision becomes collective In order to resume market equilibrium. They feel that these children free ride on the effort of Hong Kong taxpayers. 47 .crowded ward and give birth with another woman in the same delivery room at the same time. there was an upsurge in Mainland pregnant women. nevertheless. shouldered by Hong Kong taxpayers. The costs are. Hong Kong people show anxiety over this situation as they feel that their contributions to the society are subsidizing children whose parents have done nothing to contribute to the economic prosperity of Hong Kong. irrational behaviour. Furthermore. government has taken measure to internalize the costs to the Mainlanders and tackle the problem of externality. providing education. coming to Hong Kong for the purpose of giving birth. and welfare to these Hong Kong born children to Mainland parents are not without cost.
delivery room. extra charge. Some local mothers-to-be were forced to pay extra to get a place in private hospitals. The number of Mainland women giving birth in Hong Kong in 2005 increased almost 3-fold over that in 2001. for non-Hong Kong resident seeking 48 . At that time. The sudden increase in the number of Mainland pregnant women induced congestions in public ward. Policy after September 2005 Hong Kong government noted the problem and tried to regulate the situation by imposing a negative incentive. Together with the long-term benefits to their children and the relaxation of Two Way Permit (TWP) requirements. there was an upsurge in the Mainland mothers coming to Hong Kong for giving birth. pressure on medical staff and affected the quality of service provided to local pregnant women. thousands and thousands of Mainlanders came to Hong Kong for giving birth. 300 for one-day hospitalization in public ward. as the public hospitals had no vacancy left. the charge for obstetric service in Hong Kong for non-Hong Kong residents was just HK$3. The private cost for Mainlander was far below the social cost of giving birth in Hong Kong.Policy before September 2005 After Hong Kong Court of Final Appeal confirmed the status of Hong Kong born child to Mainland parents in 2001. with delivery service included.
required all Mainland pregnant women to pay HK$19. Besides.800 deposit upon admission to hospital in order to avoid defaulted payment. one year after the implementation of increased charge for the obstetric package. they might simply remain in China. The major reason It is was that the charge was not effectively set to bring the market back to optimum.000. A HK$20.000 when one can save HK$80. In 2006. the number of Mainland women gave birth in Hong Kong increased 30% from 19538 in 2005 to 20577 in the first ten months of 2006. For those could not This Pigouvian tax adopted by the government proved to be ineffective in solving the problem. Another purpose was to bring the charge level of public obstetric service closer to that of private hospital. in September 2005. The rational behind was that by increasing the price level.000 obstetric package was introduced The package included delivery and care fees in a public ward It also came along with a deposit system that for the first three days in the hospital. so that Mainlanders who could afford the charge might rationally decide to give birth in private hospitals in order to get better medical treatment and service in return. afford HK$20. the marginal private cost after the 49 . quite ironic to set the charge at HK$20. the cost of giving birth in Hong Kong was internalized to Mainlanders seeking the service.000 by fleeing from one-child policy penalty.obstetric service in public hospital.
hk/pdf_e/e47ch05. They knew that Hong Kong hospitals would not deny service due to lack of means.pdf 50 . Source : ‘Hospital Authority : management of outstanding medical fees’. the obstetric package did not come along with new initiatives in preventing and collecting defaulted payments as many of the defaulted payments ended up as bad-debt. Although the Authority required every non-Hong Kong resident to make deposit upon admission for giving birth. 69 The bad debts of Hospital Authority amounted to HK$2.800 million in 2005/06 financial year. Another reason why the package could not reduce the number of Mainland pregnant women coming to Hong Kong was that the cost could not successfully be internalized to the consumers. there existed a loophole that allowed Mainland women to obtain obstetric service without making deposit.aud.implementation of new charge was still far below the marginal social cost. Furthermore. HKSAR Government. the cost of delivery could not be internalized to them and could not bring the market to optimum. It coincides with the criticism over Pigouvian’s theorem that the government is incapable of setting an optimal level of charge or tax to attain market equilibrium. http://www.69 As Mainlanders can easily escape from making payment. they then sought last-minute hospital admission before delivery through the A&E ward. Audit Commission.gov.
They urged the government for solution to ensure sufficient public obstetric service is reserved for local pregnant women. A group of 30 local mothers-to-be marched to Central Government Office to air their grievances over the situation in November 2006. Different pressure groups. Some suggested having the Basic Law amended or reinterpreted while 51 . duration of stay after delivery and number of postnatal checks entitled by every baby and mother have been reduced.CHAPTER FOUR NEW POLICY IN FEBRUARY 2007 Introduction The ever-increasing number of Mainland mothers coming to Hong Kong for giving birth has reached an unsustainable level. quality of service delivery has declined significantly. existing medical staff manpower can no long cater for the increasing workload. Speculations on the possible solutions and development over the issue can be seen on the headline of the newspaper almost everyday. The action by these groups of pregnant women had tremendous effect. Legislative Council members and the public have urged the government to face the problem. Public hospitals are overcrowded.
000. All were rejected by the government. the charge for delivery in public hospital increased from HK$20. The official objective of the new measures is to ensure sufficient public obstetric service is available to local pregnant women. 2007 when the new measures were implemented.000 to HK$39.000 is the minimum rate that covers the charges for the delivery (vaginal or operative) and the first three days of hospitalization in general wards for the 52 . The policy Pregnant women of other nationalities were not bounded by these rules. Health. The New Policy Increase in Charge Effective from February 1. a centralized booking system. and Food Bureau finally came up with a package of new measures to tackle the problem. After months of meetings with Mainland authorities. was tailor-made solely for Mainland women. HK$39.some suggested withholding the baby’s birth certificate until the parents have settled their hospital charge. and strengthening of immigration control. The authority’s explanation was that the number of pregnant women from other countries seeking obstetric service in Hong Kong was not common. Welfare. The measures include increasing the charge.
concerned delivery. their babies. So that the Mainland mothers will shift to The imposition of HK$9. The major aim of doubling the service charge was again to make it closer to or even over the price level set by private hospitals. the consumers will never see the real costs of their consumption. Defaulted Payment Prevention Mechanism As mentioned in last chapter. and medical staffs. the Mainland mother-to-be is required to produce proof of address. who have outstanding fee will only be provided with 53 . the Hospital Authority implemented several measures for collecting outstanding medical fees.000 additional charge was to deter It also Mainland pregnant women from seeking obstetric service in the last minute. Authority will defer submission of birth data to Birth Registry for Mainlanders until outstanding fees are paid up to 42 days. encourages the Mainland pregnant women to have prenatal checks before their delivery in order to reduce the risks to the mothers. An additional HK$9. the Additionally. To effectively internalize the costs to the Mainland mothers. Upon registration. Those. private hospitals.000 will be charged for those who have not made a prior confirmed booking for their delivery and / or have not undergone the antenatal checkup provided by the Hospital Authority during the pregnancy. including both Hong Kong residents and non-Hong Kong residents. without an effective defaulted payment system.
70 Discussion Paper on ‘Impact of the use of Obstetric Services by Mainland Women on Public Hospital Resources’ by Legislative Council Panel on Health Services.emergency services. ‘Authority cashes in on pregnancy policy’. Every Mainland woman must make prior booking in person and settle the Priority is reserved for local women and only when extra In any case.6 million revenue to Hong Kong Government within in single day. the number of full payment in advance.000 for giving birth to a baby are countless. payments. (8 January 2007). 54 . People in Mainland China are getting wealthier. Therefore. the government implemented other supporting measures to ensure sufficient obstetric service is available to local pregnant women. South China Morning Post. the Authority is also exploring the possibility of hiring international debt collection agency for pursuing Mainland bad debts. Centralized Registration System The Bureau developed a centralized booking system for both private and public hospitals. Furthermore. the government knows clearly that the problem cannot be solved solely by increasing the service charge. quotas are left will be allocated to Mainland women. People who can afford HK$39. 71 On the first day of the implementation of this new measures. CB (2) 761/06-07(03). Mainland people might still find HK$39. (2007-02-02).70 Having learnt from previous lessons.71 Besides.000 worthy as they can flee from one child policy penalty and their children can enjoy Hong Kong social welfare benefits. totally 734 Mainland pregnant women made registration through the Hospital Authority centralized booking system and brought HK$28. administrative charge will be imposed for late Finally. LC Paper No.
Body check facilities and medical officers were stationed in all checkpoints to provide advice on the physical conditions of the non-local pregnant women. In spite of the rush. Tightened Immigration Control The Bureau also anticipated that those who have not made reservation nor had no money might try to get through the immigration control points by concealing or disguising their pregnancy. Every Mainland mother-to-be is required to produce such certificate to Entry of those Mainland women at immigration officer upon entry to Hong Kong. the authority has defined ‘advanced stage of pregnancy’ as being pregnant for more than 7 months i. 28 weeks. The public generally welcomed the policy which had considerably released their anxiety over the situation. 72 To avoid dispute.e.000 per year.quota for Mainland mothers would not exceed HK$12. a booking certificate will be issued to them. 55 . the advanced stage of pregnancy72 who have no booking would be denied. Those who were found to be pregnant for more than 28 weeks and without booking certificate will be denied entry. pressure groups or politician at the time it was implemented. there was no big opposition or objection from the public. The new policy was put forward in January 2007 and was fully implemented in February. After the Mainland women have made the reservation.
Welfare. In the first nine weeks of the new policy until April 4. 1.CHAPTER FIVE EVALUATION OF THE NEW POLICY Introduction According to the figure released by the Health. (2007-04-16) 56 . Besides. Mainland pregnant women seeking emergency delivery service even dropped by 75%.800 Mainland women gave birth in Hong Kong. totally 3.190 of them gave birth in public hospitals. 2007. charge for cross-border couples could fall to HK$20. the number of Mainland pregnant woman giving birth in Hong Kong public hospitals dropped significantly after the implementation of the new measures in February 2007.000’ SCMP (2007-04-17) and ‘內地孕婦來港分娩個案降 4%’ Singtao Daily. When compared with the figure of the same period last year. 371 of them sought last-minute obstetric service from emergency wards. and Food Bureau. the number seeking services from public hospitals dropped significantly by 35%. although the total number of Mainland women coming to Hong Kong only dropped by 4%.73 By looking at the figure. it seems that the new measures have successfully shifted the Mainland mothers-to-be from public to private hospitals. the implementation of centralized booking system together with immigration control has 73 ‘Birth fee drop for wives .
this chapter will evaluate the new policy by referring to the choice and design of the policy instruments. Sticks and Sermons.C. Pp. USSA New Brunswish : Transaction Publishers. since the new policy has been implemented for just two and a half months. Certain instruments fit certain problems and objective better than other instruments. The study of policy instruments then can be useful in strengthening the predictive capacity of policy analysis that would be helpful in policy design. Rist R. Carrots. (1998). while the instrument choice is real and will have immediate consequence75. Therefore. Policy Instruments and their Evaluation.74 As a broad policy objective is to be achieved far in the future.F. the duration is too short to see the real effectiveness of the policy. Vedung E. this chapter will be the evaluation of the new policy with focus on its design and implementation. it is good to know something about the potential effects of different policy instruments before one chooses among them. (1987) ‘Instruments and strategy in public policy’. these responses are called instruments. instead of focusing on the output of the policy. Richard F. Therefore. Elmore stated that certain types of problems predictably bring into play certain responses from policy makers. R. 41.deterred people from seeking last-minute service from the emergency wards. strengths. 57 . 74 75 Elmore. Different policy instruments have different operating characteristics. Bemelmans-Videc M. and implementation problems. However. Policy Studies Review.
and legitimacy77. Vedung E. all phases of the policy process. 77 Bemelmans-Videc M. there should be some criteria by which to judge the adequacy of the policy the criteria of ‘good governance’ – the central values of which government actions is appraised. 1993. (1998). Pp. According to Marie-Louise Benelmans-Videc. implementation and utility of social intervention programmes. the values of good governance include effectiveness. P.C.76 Evaluation of a policy cannot do away with figures and data on the In fact. policy outcome. Newbury Park. design. from problem analysis through monitoring implementation to the appraisal of the actual result of the policy can be evaluated. USSA New Brunswish : Transaction Publishers. When evaluating a policy. Apart from ‘output / outcome evaluation’. Evaluation : A Systematic Approach. efficiency. there is also ‘process evaluation’ where the evaluation focuses on the process of designing and implementing of policy or programme.What is Evaluation? Evaluation is the systematic application of social research procedure for assessing the conceptualization.E. 76 Rossi. Sticks and Sermons. 5. no matter ‘output evaluation’ or ‘process evaluation’. which is generally referred as ‘output / outcome evaluation’. legality. Rist R. Pp.H. 58 . Carrots. and H. CA : Sage. 41. Freeman. democracy. Policy Instruments and their Evaluation.
policy instruments that score high on the democracy criterion often have a price tag in terms of their efficiency. instrument. The final value is legitimacy. Therefore. Democracy is the degree to which administrative action in designing and implementing policies correspond with accepted norms as to government-citizen relationships in a democratic political order.C. Pp. It includes both positive and negative effects brought by the policy Efficiency refers to the input-output ratio of the policy instrument. e. which is the degree to which government choices are perceived as just and lawful in the eyes of the involved actions. while at the same time they compete or conflict. Sticks and Sermons. a prioritizing process. (1998).g. 6-9 59 . Vedung E. It includes the problems of implementation of the policy instrument through devised means. USSA New Brunswish : Transaction Publishers. These central criteria of good governance need to be combined. Policy Instruments and their Evaluation. Rist R. Legality means the degree of correspondence of administrative action in designing and implementing policies with the relevant formal rules as well as with the principles of proper process. and a balancing act.Effectiveness is the degree of goal-realization due to the use of certain policy instrument.78 78 Bemelmans-Videc M. Carrots. the choice of policy instrument instruments is a search for optimum solution.
81 79 Bemelmans-Videc M. policy instruments are categorized by the degree of authoritative force or degree of constraints involved in the government effort. and information. Sticks and Sermons. Carrots. policy instruments can be categorized in many ways.80 Regulation is often chosen by the governments as a policy tool because it appears to be more certain and effective as regulatory instruments define the norms. 81 Bemelmans-Videc M. Pp. By such. Vedung E. 31.Classification of Policy Instruments Nowhere in the international literature on policy analysis and public administration is to be found a uniform.C. Carrots. 80 Ibid. Policy Instruments and their Evaluation.79 Regulatory Instrument Regulations are measures undertaken by government to influence people by means of formulated rules and directives that mandate receivers to act in accordance with what is ordered in these rules and directives. Pp. (1998). 59. (1998). Sticks and Sermons.C. USSA New Brunswish : Transaction Publishers. 59. policy instruments can be defined as regulation. acceptable behaviour or to limit activities in a society. Policy Instruments and their Evaluation. The In this paper. Rist R. USSA New Brunswish : Transaction Publishers. imprisonment. economic means. Vedung E. 60 . Pp. and other type of punishment. Rist R. Regulations often associated with threats of negative sanctions such as fines. generally embraced classification of policy instrument.
because they hesitate to take the measures required to get it. Sticks and Sermons. Policy Instruments 61 . (1998). Carrots. Policy Instruments and their Evaluation. USSA New Brunswish : Transaction Publishers. (1998). effectiveness also greatly depends on the nature of the policy context. What makes economic policy instruments different from regulations is that the addressees are not obligated to take the measures involved. and other valuables to pursue certain actions.83 Taking cigarette consumption in Hong Kong as an 82 Bemelmans-Videc M. Rist R. Vedung E. Economic Instrument Economic policy instruments involve either handing out or the taking away of material resources from the addressees to make it cheaper or more expensive in terms of money. Carrots.71. The effectiveness of a regulatory instrument is associated with its legitimacy. Rist R. Pp. Vedung E.82 An illegitimate regulation might lead to non-compliance and the cost of non-compliance might even greater that the cost of the problem itself. which also determines the capacity of the government organization to ensure compliance.Regulatory instruments are not without weakness.C. 83 Bemelmans-Videc M. Additionally. time. It is argued that regulations are ineffective in changing behaviour if there no social consensus around the government policy underlying the regulatory instruments.C. Sticks and Sermons. effort. They may decide not to make use of the government incentive. either positive or negative.
the government imposes heavy tax on it and makes the smokers’ habit more expensive. in which case economic incentive or disincentive has been unnecessary. Information The third type of instrument is information which influences people through the transfer of knowledge. since cigarette smoking is hazardous to health. How the and their Evaluation. Instead of formulating rule to totally ban the purchasing of cigarette in the market. USSA New Brunswish : Transaction Publishers. citizens are informed of what is right or wrong. good or bad. the addressee might already have decided to behave in the desired way. The addressees have the right to choose. communication of reasoned argument and persuasion. Sometimes. the effectiveness of economic instrument must rely heavily on the relationship between the economic incentive and the policy goals. the government fells the need to do something to discourage people consuming cigarette. 84 Through advertisement. Economic policy instrument is flexible and usually has higher legitimacy when compared with regulatory instruments. 62 . as the addressee has no obligation to follow the regulation. 84 Ibid.example. amassing and packaging etc. education. 33. However. Pp. Pp. 32-33. diffusion of printed material.
It increased the public obstetric service charge for Mainland women from HK$20.000.people should act and behave and what people are allowed to do. Carrots. Vedung E.C.86 85 Bemelmans-Videc M. (1998). meaning. Rist R. 86 Bemelmans-Videc M. Evaluation of 2007 Policy Policy Instruments The policy implemented in 2007 is a combination of economic. It is worth highlighting that information can be either a policy instrument in its own right or a metapolicy instrument in the sense that it is used to disseminate knowledge of the existence. (1998). Rist R. Pp 79. Vedung E. Sticks and Sermons. and availability of other policy instruments. USSA New Brunswish : Transaction Publishers. Mainlanders are not obligated to pay the adjusted service charge. Sticks and Sermons. Carrots. Policy Instruments and their Evaluation. USSA New Brunswish : Transaction Publishers.000 to HK$39. 48. 63 . They can choose not to come to Hong Kong for giving birth if they hesitated to give the amount of money or they can seek service from private hospitals in Hong Kong.C. The financial disincentive increased the cost of action and prompted the addressees to undertake activities that will achieve the goals of the government. Policy Instruments and their Evaluation.85 The former refers to information as a policy instrument while the latter refers as information on policy instrument. regulatory. Pp. and informative policy instruments.
000. Those seeking obstetric service without registration will be penalized for HK$10. Many new policies in Hong Kong in recent years like to use information either as a tool or as a package. and consultation papers to raise people attention on the subject. Those Mainland women at their advanced stage of pregnancy without booking certificate would be denied entry. we do not see large-scale promotion or publicity on this policy in Hong Kong. There is also yearly quota that set the upper limit of vacancy allocated to Mainland women to ensure sufficient obstetric service is available to local women. there are advertisement. policy formulation is the art of choice making. since the target of this policy is Mainland women. it imposed regulations requiring all Mainland obstetric service seekers make prior registration and settle full payment before delivery. press release. Choice of instruments From policy instrument perspective. However.To avoid defaulted payment and enhanced the effectiveness of the policy. body check facilities are put in place in border checkpoints to ascertain the health condition of pregnant Mainland women. There are two factors which shape the choice of policy makers : the first one is the 64 . To avoid non-compliance. Well before the policy is put forward.
L. Summer 1987. Educational Evaluation and Policy Analysis. 2. Elmore. 151. No. Sticks and Sermons. Some focused on the problem of defaulted payment. the government announced its plan in tackling the service seeking behaviour of Mainland pregnant women while no extremely authoritative measures as 87 McDonnell. 88 Bemelmans-Videc M.C. Carrots.87 The decision making process is an exercise of give and take which involves the trade-offs of effectiveness and efficiency. Pp 144. ‘Getting the Job done : Alternative Policy Instruments’. Policy Instruments and their Evaluation. 9.F. Some even suggested amending Basic Law to redefine the residential status of children born in Hong Kong with Mainland parents. the political and fiscal costs of selecting a particular instrument.. and the different constituent pressures faced by the policy maker.88 In late 2006 when the issue received the hottest debate. Vol. USSA New Brunswish : Transaction Publishers.problem identification and the second is the resources and constraints faced by policy makers. (1998). R. Pp. Vedung E. 65 . In January 2007. some focused on the residency of the children while some focused on the quality and availability of obstetric service in public hospitals. There were suggestions to request Mainland pregnant women to pay deposit upon entry at border checkpoints and withhold the issue of birth certificate to their children if they fail to settle the hospital bill. the capabilities of implementing institution.M. different people had different focuses on the issue that led to different proposals on the solutions. Rist R.
it can reduce the possibility of defaulted payment. Ka-ling case89 in 2002. the Director of Immigration. Instead of implementing absolute prohibition. The political cost and the After NG cost of non-compliance are so high that the government cannot afford. More importantly. which will relieve the problem of 89 NG Ka-ling and others v.listed above could be seen in the proposal. there is no need to totally deny service to non-local women. As the policy objective is to ensure sufficient obstetric service to local pregnant women. reinterpretation of Basic Law became a taboo of Hong Kong government which was condemned to have ruined the autonomy of Hong Kong under ‘One Country. The possibility of seeking reinterpretation was ruled out by the Secretary for Security on the first day it was proposed. 14 of 1998. Although these measures will surely bring effectiveness and efficiency due to their degree of coerciveness. the children born in Hong Kong might become our future workforce. On one hand. Two System’. FACV No. On the other hand. Hong Kong government chose conditional prohibition. the prior registration requirement allow the authority better control the number of Mainland pregnant women seeking public obstetric service. 66 . the level of legitimacy would induce difficulties in implementation. which granted permission to Mainland women to come to Hong Kong if they have fully settled the obstetric service charge in advance.
the imposition of yearly quota ensured sufficient obstetric service is available to local pregnant women. Regulation seldom results in uniform compliance. HKSAR Government. the policy doubled the service charge to make the charging level of obstetric service in public hospital more inline with that in private hospitals. there are still intermittent reports on Mainland women gained entry to Hong Kong by 90 2006 Population By-census. 67 . the authority also set up body check facilities in border checkpoint to ascertain the pregnant women’s medical condition. Finally. There is always individuals resist compliance if by doing so they can reap positive benefits. Census and Statistics Department. 27% of the total population will be aged 65 and above. Apart from prior registration system to prevent defaulted payment.the ageing population faced by the society. However. which is the goal of the policy. In the meantime. The economic mean has changed people’s behaviour and successfully shifted the service seekers from public hospitals to private hospitals. The government then put in place series of measures to avoid non-compliance.90 Allowing Mainland mothers to give birth in Hong Kong is one of the methods in ensuring the sustainability of Hong Kong population growth. With the consistently low birth rate. it is estimated that by 2030.
Government’s explanation was that non-local pregnant women from places other than China are a clear minority and would not pose threat to the Hong Kong public medical service just does not sound convincing. which means pregnant women from USA. it is not a perfect policy. the policy is discriminatory in nature.disguise or forgery. a Mainland woman crossed the border with a forged registration certificate that was issued by a medical practitioner in Hong Kong. Sri Lanka. and Thailand etc are not required to make prior registration for giving in Hong Kong. what the government can do is to reduce the variation of behaviour to a tolerable level because the enforcement cost for uniform compliance is prohibitively high. Recently. The way the policy is designed is unexpectedly insensitive which made it subjected to challenges. Design of Policy However. Japan. they only have to pay HK$20. UK. 000 for giving birth in Hong Kong. In fact. Firstly. It only applies to Mainland women. What more. it also has its downsides. Women from all other countries are not covered by the new policy. If the policy goal is to protect the welfare of Hong Kong pregnant 68 . They would not be any barrier from entering Hong Kong solely on the ground of pregnancy. Other illegal acts such as illegal smuggling of pregnant women from Mainland China to Hong Kong and overstaying in Hong Kong waiting for delivery are common.
They found it unfair as they are required to pay extra for service and welfare entitled by every Hong Kong people.577 Mainland women coming to Hong Kong for giving birth in the first 10 months of 2006. Fifty Hong Kong males who have wives in Mainland China marched to Central Government Officer on April 1. the new service charge should apply to all obstetric service seekers from all over the world. 000 even if they have money as they found it unfair to be treated differently. the policy was criticized for failing to take care of the real need of Hong Kong people. The figure in the first three months after the implementation of policy has initially approved the policy’s effectiveness in reducing Mainland women’s demand over public obstetric service. The legitimacy of the new policy is doubtful. 39% of them are married to Hong Kong males. Among the 20. feasibility. 2007 and May 13. and legitimacy. These Mainland women expressed that they will not pay HK$39. Moreover. Conclusion The choice of policy instrument appears to have stricken a balance between effectiveness. After the 69 . Their grievance over the policy is understandable.women. 2007 to demonstrate against the new policy. instead of just targeting Mainland pregnant women.
implementation of the new policy. registration system and immigration control have deterred people from taking free lunch.190 of them gave birth in public hospitals. 70 . the successfully shifted the demand from public to private hospitals. compared with the figure of the same period last year. 1. there is a significant reduction in the number of Mainland pregnant women giving birth in public hospitals.800 Mainland women gave birth in Hong Kong. According to the figure released in early-April 2007. among the 3. It dropped by 35% when The new pricing system has Besides.
In the three months after the implementation. The number of Mainland pregnant women seeking obstetric service between February and April this year dropped by 37% when compared with the figure of the same period in 2006. problem really solved? However. the goal of relieving the pressure of public obstetric service has been achieved by shifting Mainland pregnant women from public hospitals to private hospitals.170 registrations for obstetric 71 . Hospital Authority received 10. of the new policy. the implementation of the policy has been a success.CHAPTER SIX THE WAY FORWARD Introduction Judging from some key indicators of policy outcome such as the number of Mainland women giving birth in public hospitals. The primary worry is the implication of Mainland children's In the first nine weeks after the implementation inclusion in our society in the end. is the Does it mark an end to Hong Kong people’s anxiety about the influx of Mainland immigrants? Long Term Implication Government knows that Hong Kong people's concern is not just the availability of obstetric service.
housing facilities. medical The services. implication for Hong Kong resources will be significant. Hong Kong residents. Besides. married with Mainland wives. In fact. 91 ‘Birth fee drop for wives . August 2006 to March 2007. the demand of From welfare services from these newborn babies has surfaced progressively. Source : Social Welfare Department. its implication cannot be overlooked. there were signs of deepened social disintegration after the issue became the center of discussion last year. and other welfare services of Hong Kong. from Mainland women91. Social Disintegration The uncertainties faced by Hong Kong people made them worry and anxious. charge for cross-border couples could fall to HK$20. (2007-04-16) 92 The applicants’ ages ranged from two months old to 17 years old. Based on this figure.000’ SCMP (2007-04-17) and ‘內地孕婦來港分娩個案降 4%’. there were 102 children born to Mainland parents applied for Comprehensive Social Security Assistance (CSSA)92.services. 72 . it is estimated that the number of registration will reach twenty or even thirty thousand by the end of 2007. Singtao Daily. They are all entitled to the education. in both private and public hospitals. The figure might seem trivial when compared with the total number of children born to Mainland parents every year. However. we will commit the same mistake as committed by our judges in CHONG Fung-yuen case in 2001. Otherwise.
That means Mainland women married to Hong Kong residents only have to pay HK$100 per night for giving birth in public hospitals. the objective of the policy has to be re-oriented to meet the real need of Hong Kong people. Other Hong Kong people argued that allowing Mainland women married to Hong Kong males to give birth in Hong Kong at normal rate would expose our medical resources to exploitation. The best and simplest way in achieving this is by standardizing the service charge for all Hong Kong families. The welfare of those Hong Kong residents with Mainland wives should be cared for equally.complained that they are discriminated and are not provided with the same rights and benefits enjoyed by other Hong Kong residents. By doing so. the government can show its care and support to all families in Hong 73 . Restructure of obstetric service policy Reorienting Policy Target First. the government should focus its effort on the long term planning in order to balance the population and the resources. This can be achieved by restructuring the current policy on obstetric services and better management of welfare resources. the policy should aim at protecting the right and benefit of Hong Kong residents as a whole. Instead of protecting the benefit of local pregnant women. With the short-term problem being solved.
there were 10.170 Mainland women registered for obstetric services in Hong Kong. Extending Quota Coverage Secondly. as their children might be educated. 3756. around 36% of them sought service from public hospitals 93 . Increasing Charge for Couples who are Both non-Hong Kong Residents Thirdly. the quota system should extend to cover the registration in private hospitals. Mingpao (2007-04-13) 74 . living. Mainland women giving birth in private hospitals might pose unbearable pressure on the resources of Hong Kong at a later date. Without proper control. As most of the opposition of the current policy was from Mainland women married to Hong Kong residents. From February to April. for those couples who are both non-Hong Kong residents wishing to give birth in Hong Kong. to better manage the number of Mainland women giving birth in Hong Kong. Under current policy. the quota system is not applicable to private hospitals.Kong without differentiation which would definitely be beneficial to restore social harmony. the above-suggested policy would gain support that is more public. and seeking medical 93 “內地婦急症室產子減 75% 四成不付款”.
Supportive Measure As the charge is so high. I) Immigration Control An experienced Immigration officer served in Lok Ma Chau border-crossing point revealed that in the past few months after the implementation of the new policy. The payment is expected to be in line with the amount of the one-child policy penalty i. Series of measures have to be put in place to avoid non-compliance.000. around HK$100. it is very likely that people will try every possible mean to come to Hong Kong illegally. they are required to pay extra as compensation to the Hong Kong government. Apart from protecting Hong Kong people’s benefits. It can be achieved by strengthening of Immigration control and implementing a defaulted payment prevention system. The whole purpose is to reduce their incentive to give birth in Hong Kong to the minimum. Mainland pregnant women without registration certificate tried different means to 75 . Those seeking obstetric services in Hong Kong would be willing and capable in paying the services. which can reduce the possibility of defaulted payment. the increase in charge has the effect in screening incoming pregnant women. The aim is not to raise public revenue.and welfare of all kinds in Hong Kong.e.
the officer should not allow the pregnant woman to leave China unless the woman can produce a valid registration certificate. these Mainland women refused to leave the hospital. First. treatment. The possibility of non-compliance can be minimized by strengthening the communication with Mainland and solving the problem by working in partnership. if a Mainland woman leaves Mainland China to Hong Kong.come to Hong Kong. Few falsified registration certificates while others became nasty when being denied entry. threatened to commit suicide if repatriated. and the Mainland public security officer at clearance counter reasonably believes that she is at her advanced stage of pregnancy. Mainland women claim feeling unwell and seek medical service from Hong Kong border-crossing points should be handed over to the Mainland public security officers 76 . Second. there were also Mainland mothers claimed feeling unwell and sought medical treatment at the border crossing points. Immigration officers had After medical They even no choice but to send these Mainlanders to the nearest hospitals. Apart from the most commonly used tricks that was disguising as non-pregnant woman. Some Mainlanders waited in the area between China and Hong Kong clearance counters and sought obstetric service from the border crossing point when they were ready for delivery. They should establish a cross-border system that cover two issues.
As the whole obstetric service policy lies heavily on the effectiveness of the immigration control. The training will better equip the officers and make them more confident and competent in carrying out their duties. it requires cohesive communication and cooperation between Mainland and Hong Kong authorities. 77 . China government should realize that such service-seeking behaviour of Mainland women is not simply a Hong Kong problem. the one-child policy will be less effective in controlling the number of population in China. Immigration Department should invest more resources in training their staffs. Training should focus on the authority empowered to Immigration officers under the new policy.who will either render medical treatment on the spot or send the women to the nearest hospitals for treatment. it needs the active participation of Mainland China. especially those serving in border checkpoints. policy of Mainland China. The system is expected to reduce the possibility of abusing medical service due to policy loophole. However. The behavior poses significant impact on the population As those babies born in Hong Kong will not be counted as China population. More importantly. the communication skills and the negotiation technique. it is a cross-border problem.
Mainland mothers can still enter Hong Kong illegally. which will be the solution to our aging population problem in the future. Those who fail to settle full service charge before they leave the hospitals will be wanted and denied egress from Hong Kong. The government should exert greater effort in promotion the positive image of these newborn babies by publicizing the benefits and advantages brought by them. the government should take actions to show her intolerance to these immigration offences and the determination in collecting full payment by criminalizing non-payment of hospital fee and charging all illegal immigrants and overstaying pregnant women with heavier penalty to deter illegal acts. these babies born to Mainland women were discriminated by other Hong Kong people that resulted in serious social segregation. The purpose is to reduce people’s incentive to come to Hong Kong for giving birth illegally. Some are illegal immigrants while some are two-way permit holders.II) Defaulted Payment Prevention System Even under strict immigration control. who have overstayed in Hong Kong after the expiration of their TWP. 78 . In these cases. They should be portrayed as the pillar of our society. Civil Education Due to excessive negative reports by the media.
Due to the ever-declining birth rate94. social assistance. Medical Service and Other Welfare Policies In 2006. Besides. and medical care in the coming decade. there was growing proportion of these newborn babies whose parents are not Hong Kong residents. medical service.hk/showtableexcel2.jsp?tableID=004. housing facilities. The most imperative one would be our education policy. 94 The number of birth in Hong Kong dropped from 85. The government should monitor the trend of the service-seeking behaviour of Mainland women and project the demand on education. All policies have to be reviewed to meet the need of our next generation. These schools are either demolished or left idle. accommodation. Census and Statistic Department. totally 127 primary schools closed down between 2001 and 2006 due to the low enrollment rate.censtatd. Education These children may seek education.Vision in Education. The government should recognize the implication of the growing number of these newborn babies and their family profile to our existing and future social policies.700 in 1990 and to 48. Housing. http://www. 63% of the newborn babies were born to mothers from Mainland China and became the major source of population growth in Hong Kong. Many teachers lost their jobs and many students are forced to transfer to other primary schools.200 in 2001.gov. and welfare of all kinds in Hong Kong. 79 .000 in 1980 to 67.
with children born to Mainland mothers formed the major part of the population increase. it is very likely that they will not live with their parents. If these children seek education in Hong Kong. This means the whole society’s demand on education will increase in the coming decade. with our geographical layout. If the government has insight and takes a proactive role in forecasting our demand on education in the future. With the increase proportional of newborn children whose parents are not Hong Kong residents. since 2001.000 in 2006. if they remain residents in Mainland China. They successfully brought our population back to 1990 level. In the past. The number of birth rose from 48. which provide all in one services to these children so that their education.200 in 2001 to 65. On the other hand. 80 . the demand on boarding schools was low which made the number of boarding schools limited. or the government can provide the services by herself so that the quality of education and living environment can be assured. the demand on boarding schools might increase. it would take considerable time for them to travel to school.However. The government should consider either encouraging private sector to run boarding schools. Hong Kong's population has rebounded. we might be able to avoid unnecessary chaos as such. accommodation and catering are being taken care.
the existing social welfare system needed to be reviewed.Social Welfare Assistance To better protect Hong Kong people’s welfare and avoid social resources being abused. 95 To be eligible for CSSA. to ensure the assistance goes directly to the applicant. These two That means those children born to Mainland parents are all eligible for applying CSSA on the day they are born in Hong Kong. government should reduce the amount of cash assistance and explore the feasibility of using voucher or direct subsidies to service providers to avoid assistance being misused. Under current policy. any person who has been Hong Kong resident for 7 years or more and has resided in Hong Kong for at least one year is eligible for applying CSSA. as the assistance is provided to the Hong Kong born children only. These children can get HK$1. the amount and the mode of assistance also needs to be reviewed. Besides. the applicant’s capital asset should not be more than HK$34.955 per month if can pass the Social Welfare Department should develop a system with Mainland China to collect reliable information on the applicant’s financial situation to avoid deception of the social assistance programs.000 for ‘single person’ application. 81 . financial test95. Furthermore. requirements are exempted for those who are under 16 years old.
and medical service in Hong Kong while they also have the obligation to contribute to the community. Conclusion These newborn babies are Hong Kong residents. They have the right to enjoy the welfare. 82 . Whether they will become the pillar or the burden of the society depends on the government’s attitude and determination in nurturing them and builds their sense of belonging towards Hong Kong that makes them recognize Hong Kong as their home. it is not the purpose of this paper to list out all policies the government has to review. which is an irrebuttable truth. education. However.The government should look into far too many issues. The government should extend its focus from the availability of public obstetric service to the long-term planning of social policies to ensure sustainable development of Hong Kong society as a whole. The objective of this section is to highlight that the government should note the significant implication brought by these newborn babies to our society.
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5%) 19538 (34%) 20577 (39.5% 61. 87 .4% 31.6% Year 2001 2002 2003 2004 2005 2006 (first 10 months) Source : Discussion Paper on ‘Impact of the use of Obstetric Services by Mainland Women on Public Hospital Resources’ by Legislative Council Panel on Health Services.6%) 13209 (26.3%) Year 2001 2002 2003 2004 2005 2006 (first 10 months) Number of Births in HK 48219 48209 46965 49796 57098 52265 Family Profile of babies born to Mainland mothers Total No.7% 20.1% 47. (8 January 2007). CB (2) 761/06-07(03).Annex A Birth Statistics Total Number of Birth in Hong Kong Number of babies born to Mainland women in HK (% to the total number of births) 7810 (16%) 8506 (17.9% 14. of babies Number of babies % to the total number born to Mainland born to Mainland of babies born to women women in HK Mainland women 7810 8506 10128 13209 19538 20577 620 1250 2070 4102 9273 12678 7. LC Paper No.6%) 10128 (21.
Mainland China reduced the OWP quota from 150 to 75 per day Signing of Sino-British Joint Declaration. Outbreak of Cultural Revolution in Mainland China Introduction of ‘reach based’ policy. Hong Kong Government introduced a quota system to balance the numbers of those entering into and those leaving the Colony. Mainland China increased the OWP quota from 75 to 105 per day 1950 1950 1950 1966 1974 1980 1980 1983 1984 1993 88 . Abolition of ‘reach based’ policy China and British governments finally reached an agreement on the daily quote of One Way Permit. which brought Hong Kong entrepot trade to a standstill. Outbreak of Korean War The United States imposed an almost complete embargo on Chinese trade. natives of Guangdong province were exempted. Maximum 150 legal immigrants were allowed to enter Hong Kong for settlement per day.Annex B Chronology of Major Events affecting Hong Kong Immigration Policy on Mainlanders 1841 1940 1941 1949 Hong Kong became British colony Immigration Control Ordinance introduced Second World War Immigration Control Ordinance stipulated that no person may enter into the Colony without an entry permit.
Court of Final Appeal ruled that any person born in Hong Kong is Hong Kong residents in CHONG Fung-yuen case SARS Outbreak Introduction of Individual Visit Scheme 2001 2003 2003 89 .1995 1997 1997 1998 1998 The daily quota for OWP further increased to 150 per day Change of sovereignty Hong Kong hit by Asian Financial Crisis Unemployment rate of Hong Kong reached 7% Introduction of ‘Shangwu’ (Business visit) endorsement for Two-way Permit. Relaxation of ‘Tanqing’ (Relative visit) endorsement requirements.
Annex C Growth of Population in Hong Kong (1841 – 2006) 8000 7000 6000 5000 4000 3000 2000 1000 0 1841 1851 1861 1871 1881 1891 1901 1911 1921 1931 1941 1951 1961 1966 1971 1976 1981 1986 1991 1986 2001 2006 Thousand(s) Year Source : The figure from 1841 – 2001 were taken from CHAN. (eds) Immigration Law in Hong Kong : An Interdisciplinary Study. 90 . Hong Kong : Sweet & Maxwell Asia (2004) The figure for 2006 was drawn from Census and Statistics Department. B. J. HKSAR Government.. Rwezaura. ‘The Evolution of Immigration Law and Policies : 1842-2003 and Beyond’ in CHAN J.
Annex D Map of Cities covered by Individual Visit Scheme in 2007 Changchun Shenyang Beijing Shijiazhuang Dalian Tianjin Jinan Wuxi Suzhou Wuhan Shanghai Chengdu Nanjing Hangzhou Chongqing Ningbo Changsha Taizhou Fuzhou Nanchang Guiyang Quanzhou Xiamen Nanning Kunming Zhengzhou Hefei Haikou 91 .
of Mainlanders Visited Hong Kong (1997 – 2006) Million(s) 14 12 10 8 6 4 2 0 8.Annex E No.46 m * 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Year * Individual Visit Scheme implemented in Mainland China in July 2003. Source : Tourism Board 92 .
260 HK$34.000 – HK$25.800 – HK$25.000 HK$26.180 – HK$30.800 Normal Delivery Kong residents. Paul Hospital HK$12.000 Baptist Hospital (香港浸信會醫院) St. HK$15.800 – HK$17.000 – HK15.Annex F Obstetric Service Charges in Hong Kong Private Hospitals Service charge for Hong Service Hospital Kong residents Normal Delivery Hong Sanatorium Hospital (養和醫院) and HK$32.700 HK$94.000 93 .000 Fee HK$13.500 – HK$15. charge Caesarean Delivery for Special Women Arrangements Mainland mother for Mainland Pregnant Kong HK$13.500 HK$80.800 – Same as charges for Hong (港安醫院) Hong HK$41.600 – Same as charges for Hong Administration HK$51. Fee Kong HK$13.200 – HK$42.780 Kong residents.000 – HK$52.800 – Same as charges for Hong Administration HK$32.000 Adventist Hospital HK$15.800 – Same as charges for Hong Deposit for Mainlanders HK$50.000 ward) HK$100.000 HK$33.000 – HK$27.280 HK$28.880 HK$42.880 HK$37.800 HK$488.100 Kong residents.000 Caesarean Delivery HK$43.100 – HK$16.000 HK$45.680 – HK$15. HK$10. Hospital (聖德肋撒醫院) Union Hospital (仁安醫院) Teresa’s HK$13.000 ward) (private (general St.000 HK$100.000 – HK$28.000 – HK$24.500 Kong residents.000 – Additional Administrative (聖保羅醫院) Canossa Hospital (嘉諾撒醫院) HK$25.880 – HK$18.000 HK$15.800 HK$85.00 Charge – HK$1.000 – HK$35.