I spent the festive holidays
quietly, except for a short trip to Po Lam Monastery for a yearly gathering in
Lantau on the coldest day. I walked
uphill in freezing rain without an umbrella, appreciating the advance in
technology of clothing to keep me warm and dry. I was also lucky enough to barely miss the risk
of being hung in a 360 cable car, which apparently prepared every passenger
ready for frozen section.
I finished two books on similar topics by the same author: Richard WISEMAN.
WISEMAN (what a name!) is a Professor of
the Public Understanding of Psychology at the University of Hertfordshire. He was a magician before he graduated in
Psychology and then
obtained his Ph.D. in Psychology. He was fascinated by the quirky side of human
behaviour such as lying, decision-making, superstition and fortune telling. In his two books: “Paranormality” and “Quirkology”,
I learn about a quick test to distinguish good and bad liars by drawing a “Q”
on your own forehead with your index finger of your dominant hand. I also learn about a script for fortune
telling which most people would find it an accurate description of them. There are also experiments elucidating
mysteries of Ouija boards, out of body experiences, subliminal perception etc. However, what enlightens me most is that his
studies go beyond reviewing how such paranormal phenomena come about. They further look into why people tend to
behave in these ways and cling to such phenomena.
After reading the two books, I come
to an idea of my own study. One day I
found that there were so many people crowded in Cafe de Coral (a fast food
chain store, in case you don’t know) during lunch hours. I asked myself: why didn’t they go to other
restaurants for lunch? In fact they could
make a reservation at Lobster Bar or Cova (and also had the chance of meeting
Eve Lai there). So my study involves
distributing out lunch coupons to working people to see if their meal-seeking
behaviour can be modified. They will be
given $250 each in one year. However, my
study cannot be carried out because there is no one willing to sponsor it.
Don’t judge me silly or stupid
for being blind to the obvious reason of price differential governing the
meal-seeking behaviour of workers. In
fact we have been paying for such study since 2009. It is the Elderly Health Care Voucher Pilot
Scheme. This scheme is more “mission-impossible”
than my study. This is because the
subjects of the scheme are all over 70 years old. They are thus more difficult to change. They also take it more seriously on matter
concerning their health than food. Moreover,
the price differential is even greater between public and private sectors.
Well, people can do all kinds of studies
they like. It is even acceptable to
spend public money in a not-well-planned or not-so-worth manner (because it is very
common). But it is a sin to spend public
money on unsound theories, and at the same time drawing biased conclusions,
which affect the elderly and the medical profession. Apart from the two books, I have also gone
through (again) the 136 – page Interim Review of the Elderly Health Care
Voucher Pilot Scheme. It is stated
clearly that “it
is expected that the Scheme could help promote key ingredients of good primary
care among the elderly and healthcare service providers…” And that they “expect that more elderly people would be able to
choose private primary healthcare services close to their homes.”
My conclusion is that within the 2-year study
period, most of the elderly remain sane. So as expected, they do not suddenly change
their health-seeking behaviour because of the given $250 per year. And that they retain their choice for the
public services. Of course some of them
make good use of this minimal subsidy for one or two consultations for minor
ailments. However, the review shows
disappointment about the findings and tries to put the blame on the co-payment
charged by doctors on each consultation. The poor quality of the study itself and the
review is exemplified by the following:
1026 elderly were recruited for a survey. Among them, only 35% of them had actually used
the healthcare vouchers. However, “In the survey, the elderly
were asked whether, from a perception point of view, the consultation fees in
general had increased subsequent to the launch of the Scheme. 45% did not perceive any increase in
consultation fees. 42% reported that
they did not know whether the Scheme had led to any increase in consultation
fees. 14% perceived that the
consultation fees increased as a result of the Scheme.” One cannot expect a vague question than
this. First of all, this question was
answered by most of the elderly who had not used the voucher at all. There was also never any intention to clarify
the so-called perceived increase in fees. What was done was to conclude that: “The sampling survey suggests no significant degree of perceived
increase in service fees, though a small but not insignificant (no significant, but not
insignificant!) proportion of elderly
people did report perceived increase in service fees due to the use of
vouchers.” Based on such data, follow-up actions were
taken seriously. Officials formally
invited the media to report on this. Starting
from 2012, doctors have to put down the co-payment before they can register the
vouchers for the elderly. It is stated
that it is the co-payment amount that might hinder the behavioural change of
the elderly.
The damage has been done. What I can think of is to formally call for
sponsors for the following studies:
- To invite WISEMAN to design a study to see why the good intention of the Chief Executive to subsidize the elderly would be twisted in such a way.
- There had been a willingness-to-pay study in the pilot scheme. However, the wrong question had been asked. A study should be done again with the correct question: “What is the amount you are willing to pay or co-pay when there is perceived (yes, perceived, again) free lunch?”
- A follow-up study on those elderly who did show irrational behavioural changes to see whether there is any underlying pathology such as cerebral insufficiency, dementia or frontal lobe lesions.
- To introduce healthcare vouchers to young adults as they are the group who have real potential for behavioural changes and they will exert greater burden on the healthcare system now and later.
(Source: HKMA News February 2012)
