Non-attendance and effective equity of access at four public specialist outpatient centers in Hong Kong
AbstractThis study tests whether socio-economic status (SES), at either the individual or ecologic levels, exerts a direct impact on non-attendance or an indirect impact on attendance through longer waiting time for appointments and/or doctor-shopping behavior at four public specialist outpatient centers in Hong Kong. We collected information through three main sources, namely patients' referral letters, telephone interviews with both open- and closed-ended questions (e.g. doctor-shopping data) and hospital administrative databases from a total of 6495 attenders and non-attenders enrolled from July 2000 through October 2001. Individual-level SES was measured by education, occupation and monthly household income. Tertiary planning unit (TPU)-level SES data consisted of proportion unemployed, proportion with tertiary education, median income and Gini coefficient. Direct effects of SES on non-attendance were examined by logistic regression. Indirect contributions mediated through waiting time and doctor-shopping were analyzed by structural equation modeling. We found that SES, at the individual or ecologic level, did not exert a direct effect on non-attendance. Instead, TPU-level SES contributed positively to waiting time ([beta]=0.06Â±0.03, p=0.048), i.e. worse-off neighborhoods (and those with greater income inequality) had a shorter waiting time. Individual-level SES was also directly associated with the likelihood of doctor-shopping ([beta]=0.16Â±0.02, p
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Bibliographic InfoArticle provided by Elsevier in its journal Social Science & Medicine.
Volume (Year): 62 (2006)
Issue (Month): 10 (May)
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Web page: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description
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- Gabriel M. Leung & Keith Y. K. Tin & Owen O'Donnell, 2009. "Redistribution or horizontal equity in Hong Kong's mixed public-private health system: a policy conundrum," Health Economics, John Wiley & Sons, Ltd., vol. 18(1), pages 37-54.
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