Free Market, and Confucian Filial Piety: Ageing Policy, Welfare Governance and Aged Care in Hong Kong
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FREE MARKET, AND CONFUCIAN FILIAL PIETY: AGEING POLICY, WELFARE GOVERNANCE AND AGED CARE IN HONG KONG by Wai Lim Wong A thesis submitted in fulfillment of the requirements for the degree of Doctor of Philosophy School of Social Sciences and International Studies University of New South Wales 2012 Abstract This thesis aims to explain the shaping of the aged care policy in Hong Kong from 1948 to 2007. The British Colonial government borrowed the concept of community care from the United Kingdom in 1973 and ageing-in-place in 1994 to support the development of its ageing policy. Prior to 1973 provision was mainly family and society-based. Between 1997 and 2007, the Hong Kong Special Administrative Region government continued to support policies associated with the colonial government but also emphasised the centrality of family support drawing on Confucian filial piety. The problem under investigation is the contradiction implicit in Hong Kong’s social care policy for older people. The focus on Confucian filial piety and reliance on family care means that there is little provision of care in the community by the government. This thesis argues that the aged care policy in Hong Kong is more than a policy about material provision and that it engages with Hong Kong Chinese cultural identity and promotes a narrative that normalizes family care as a duty and responsibility. The shortage of home places, together with government subsidies for some of the residents and providers, has greatly encouraged the development of private aged-care. The quality of this sector is very varied. This thesis employs a three-stage analysis - which covers policy papers, the process of policymaking and the process of implementation. Newspaper and television reports on the aged care industry are also examined. The theoretical framework draws on political economy, cultural and moral economy, Foucauldian govemmentality and Rose’s ethopolitics analysis. These perspectives provide a framework for explaining how filial piety or familial support prevails in Hong Kong, in relation to Hong Kong’s welfare system and its strong commitment to the free market and a balanced budget. Originality statement ‘I hereby declare that this submission is my own work and to the best of my knowledge it contains no materials previously published or written by another person, or substantial proportions of material which have been accepted for the award of any other degree or diploma at UNSW or any other educational institution, except where due acknowledgment is made in the thesis. Any contribution made to the research by others, with whom I have worked at UNSW or elsewhere, is explicitly acknowledged in the thesis. I also declare that the intellectual content of this thesis is the product of my work, expect to the extent that assistance from others in the project 's design and conception or in style, presentation and linguistic expression is acknowledged’ Signed Copyright statement ‘I hereby grant the University of New South Wales or its agents the right to archive and to make my thesis or dissertation in whole or part in the University libraries in all forms of media, now or here after known, subject to the provisions of the Copyright Act 1968. I retain all proprietary rights, such as patent rights. I also retain the right to use in future works (such as articles or books) all or part of this thesis or dissertation. I also authorize University Microfilms to use the 350 word abstract of my thesis in Dissertation Abstract International. I have either used no substantial portions of copyright material in my thesis or I have obtained permission to use copyright material; where permission has not been granted I have applied/will apply for a partial restriction of the digital copy of my thesis or dissertation’. Signed ^ \ £~l V-2, Date Authenticity Statement ‘I certify that the library deposit digital copy is a direct equivalent of the final officially approved version of my thesis. No emendation of content has occurred and if there are any minor variations in formatting, they are the result of the conversion to digital format’. Signed Date Acknowledgments I am fortunate to have had Associate Professor Helen Meekosha and Dr. Alan Morris as my thesis supervisors. Without their inspiration, time, patience and good humour, my thesis would never have seen the light of day. I am also grateful to Associate Professor Raul Pertierra for the development of the research proposal, Professor Ann Daniel for her suggestion to compare Confucius’ and Foucault’s writings, Dr. Diana Olsberg for her insights into policy analysis, and Dr. Andrew Davidson for reminding me about the politics of governance in Hong Kong. I am particularly grateful for Dr. Alan Morris' unfailingly support during the final stage of the writing-up. My wife Suk Man and son Chi Yan have both been lovingly supportive and I am very thankful to them. Lastly, and with deep respect, I would like to dedicate this thesis to my late parents, Wong Man Ho and Wong So Shun, my late father-in-law, Chan Kit, my mother-in-law, Lai Wai Pin, and to all the elderly people in Hong Kong, who have shown me the spirit and meaning of life. Table of Contents Part I Ageing policy, residential care and welfare Page governance Chapter 1 Ageing theories, welfare governance and some 1 theoretical considerations Chapter 2 The characteristics of Hong Kong political and 27 welfare systems Chapter 3 Cultural legitimacy and Hong Kong ageing policy 53 Chapter 4 Research methodology 86 Part II The development of ageing policy in Hong Kong: a historical review 1948-2007 Chapter 5 Pre-community care policy period (1948-1972) 104 Chapterö Community care policy period (1973-1986) 138 Chapter 7 Community care and commercial care period: phase 182 one (1987-1997) Chapter 8 Community care and commercial care period: phase 212 two (1997-2007) Chapter 9 Conclusion 244 Bibliography 249 List of Appendixes Appendix 1 A list of selected events in newspapers and television 304 programmes Appendix 2 Social services expenditure as a percentage of GDP, 307 1967-2009 Appendix 3 The Five-Year Plan of community and home services 308 1979-1987 Appendix 4 The Five-Year Plan of community and home services 309 1988-1996 Appendix 5 Residential and community support services for the 310 older people 1998/99-2007/08 Appendix 6 Elderly Commission Study on Residential Care 311 Services for Elderly, 2009 List of Tables Table 1 Residential care for the older people 2009 72 Table 2 The relationships of aged home, family services and 130 public assistance Table 3 The distribution of the 60 & over population between 140 1971-1986 Table 4 The distribution and the increase of 60-64, 65-69, 141 70-74 & 75+ age cohort Table 5 Types of elderly news in Ming Pao Daily from 1999 238 to 2006 Exchange rate According to the linked exchange rate system, Hong Kong dollar is pegged to the US dollar at the fixed exchange rate of 7.8 since 10/1983, and 7.75 since 9/1998 1 US$ = HKS7.8 (since 10/1983) 1 US$ = HKS7.75 (since 9/1998) Source: Hong Kong Monetary Authority Part I Ageing Policy, Residential Care and Welfare Governance Chapter 1 Ageing Theories, Welfare Governance and Some Theoretical Considerations Introduction This thesis is a study of the historical development of the aged care policy in Hong Kong from 1948 to 2007. The study covers both the British colonial administration from just after the Second World War in 1948 to 30 June 1997, the return of Hong Kong to China, and the administration of the Hong Kong Special Administrative Region (HKSAR) under the principle of ‘one country two systems’ from 1 July 1997 to 2007. The key features of aged care policy in Hong Kong are care in the community and ageing-in-place. The policy emphasises that older people should live in the community and considers residential aged care as the last resort. This thesis aims to understand the forces underpinning the formation and development of this policy. It will also examine the relationship between the provision of community support and residential aged care, and the arguments of tradition, family and the virtue of self-reliance. I will examine the four periods of its development: the pre-community care period (1948-1972), the community care period (1973-1986), and the community and commercial care period, phases one (1987-1997) and two (1997-2007). This thesis consists of two parts. Part I Chapter 1 is about ageing theories and welfare governance, and outlines some theoretical considerations. Chapter 2 is about social policy, legitimacy and Hong Kong society. In Chapter 3, I will examine cultural legitimacy and Hong Kong ageing policy with ideas and arguments from Chapters 1 and 1 2. Chapter 4, which concludes Part I, is about methodology. The first four Chapters in Part II are about the historical development of ageing policy in Hong Kong. Chapter 5 is about the pre-community care policy period, Chapter 6 is on the community care period, and Chapter 7 is concerned with community and commercial care phase one. Chapter 8 is about community and commercial care phase two after the handover of Hong Kong to China. The last chapter in Part II is Chapter 9 and is the concluding chapter of the thesis. In this chapter, I will first introduce a recent user group’s petition concerning the provision and quality of residential care for older people, and physically and mentally disabled people, a long-neglected social welfare issue. This is followed by an introduction to3 Hong Kong as an ageing society, including a discussion of the demographic and ageing policy context.