Shifting Concepts of Autonomy in the Hong Kong Hospital Authority

The Hong Kong Hospital Authority is the main provider of public health care services in Hong Kong. It operates 41 public hospitals, 74 general out-patient clinics and 45 specialist out-patient clinics. This article examines the reason for its establishment as a statutory body in 1990 and offers an assessment of its success in meeting the goals of the reformers. A belief that health care service delivery would be improved is largely supported by the evidence, but this may have more to do with budget and policy consistency than management autonomy and flexibility. Statutory independence, with its promise of improved efficiency, has its limits in the highly complex field of health where there are multiple players and where professional autonomy remains a key claim. In recent times, the authority has been subject to several reform attempts and, together with the SARS epidemic in 2003, these have had a significant impact on its organizational structure and practices, in particular, on its degrees of autonomy.

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