Institutional analysis of elderly care ecology and actors’ dynamics in Hong Kong

Abstract

This dissertation sets off to study the causal relationship between elderly care institutional rules and actors’ dynamics. The goal is to gain a better understanding of what shapes elderly care policies; and how these policies turn around and influence actors’ dynamics once they are set. The Institutional Analytical Development (IAD) Framework is chosen as the analytical lens. The “seven rules” of the IAD Framework help identify the impact of different elderly policies on actors from 1970 till now. Process-tracing case study is used to track how different institutional setups might change the role and the behaviour of each competing actor. Two case studies, namely the evolution of the “money-follows-the-user” policy and the “role reversal” phenomenon between the public and private sectors of elderly care services, are chosen for this research. Through reconstructing the historical evolutions of both cases using documentary research and elite interviews, the researcher managed to identify causal observations that support the eight empirical findings of this research. The first finding is that the Hong Kong Government is the de facto elderly care policy owner. The second finding is that Hong Kong lacks effective opposition who has capacity to provide alternative policy proposal. The third finding is that financial incentives and availability of services are the paramount considerations among elderly service users. The fourth finding is that the ability to design a business model that meets the constraints imposed by Comprehensive Social Security Assistance (CSSA) is the main success factor for PRCH industry. The fifth finding is that the restriction imposed by CSSA scheme push private sector to develop a successful model to serve the low-income elderly. The sixth finding is that availability of resource often dictates the choice of policy option. The seventh finding is that Hong Kong elderly care policy evolution was greatly influenced by path dependency theory. The last finding is differential funding from the Government is the key causation to the “role reversal” phenomenon. A contribution is made to the understanding of how institutional rules and regulations influence actors’ behaviour and dynamics. The roles of key actors, namely the Government, the civic sector, businesses and elderly care services users, are illustrated by the process-tracing technique. The research concludes that, for most of the time, institutional rules and regulations shape the characteristics of the elderly care ecosystem and the behaviour of actors within it. As the next step, it is necessary to rethink the policy design process adopted by the Government.