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Non-attendance and effective equity of access at four public specialist outpatient centers in Hong Kong

Listed author(s):
  • Johnston, Janice M.
  • Leung, Gabriel
  • Saing, Hnin
  • Kwok, Kin-On
  • Ho, Lai-Ming
  • Wong, Irene O.L.
  • Tin, Keith Y.K.
Registered author(s):

    This 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]=0.06±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]=0.16±0.02, p

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    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 62 (2006)
    Issue (Month): 10 (May)
    Pages: 2551-2564

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    Handle: RePEc:eee:socmed:v:62:y:2006:i:10:p:2551-2564
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    1. Dunlop, Sheryl & Coyte, Peter C. & McIsaac, Warren, 2000. "Socio-economic status and the utilisation of physicians' services: results from the Canadian National Population Health Survey," Social Science & Medicine, Elsevier, vol. 51(1), pages 123-133, July.
    2. Kloos, Helmut & Chama, Tsegaye & Abemo, Dawit & Tsadik, Kefalo Gebre & Belay, Solomon, 1986. "Utilization of pharmacies and pharmaceutical drugs in Addis Ababa, Ethiopia," Social Science & Medicine, Elsevier, vol. 22(6), pages 653-672, January.
    3. Campbell, S. M. & Roland, M. O. & Buetow, S. A., 2000. "Defining quality of care," Social Science & Medicine, Elsevier, vol. 51(11), pages 1611-1625, December.
    4. Arnesen, Kjell E. & Erikssen, Jan & Stavem, Knut, 2002. "Gender and socioeconomic status as determinants of waiting time for inpatient surgery in a system with implicit queue management," Health Policy, Elsevier, vol. 62(3), pages 329-341, December.
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