The article begins by examining current issues in thinking about accountability, citizen involvement and empowerment. The discussion then moves to the particular context of Hong Kong. Recent reforms to public hospital services are reviewed in the light of the territory's traditional values of paternalistic bureaucracy and minimal citizen involvement. It is shown that despite good intentions to enhance public accountability and cgitizen involvement, in practice there has been little substantive change in the distribution of power between the ruling elite, health care professionals, and the actual service users. Whilst more information about service performance may now be available, opportunities for citizen involvement and representation continue to be carefully managed by the administration. The net result is that only a very few members of the lay public have been appointed to the new bodies that are now responsible for the governance of the public hospitals. Nearly all of those appointed to such bodies are unrepresentative of the normal service users being drawn, instead, from members of the mostly non-public hospital users - namely Hong Kong's very wealthy professional and business elites. For most of the general public, therefore, the reforms have been less about empowerment and involvement and more about informing them of the changes that have been introduced or of educating them so that abuses of the system can be reduced, or their help enlisted in locally organized fund-raising functions. The article concludes that however well-meaning the reformers might have been in terms of endeavouring to enhance accountability and citizen involvement, the impact of such efforts are likely to be seriously limited whenever underlying administrative or social values conflict with those that ostensibly guide the reforms.

Volume 22

Numbers 3-4