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

TitleNon-attendance and effective equity of access at four public specialist outpatient centers in Hong Kong
Authors
KeywordsAccess to care
Hong Kong
Horizontal equity
Non-attendance
Socio-economic status
Issue Date2006
PublisherPergamon. The Journal's web site is located at http://www.elsevier.com/locate/socscimed
Citation
Social Science And Medicine, 2006, v. 62 n. 10, p. 2551-2564 How to Cite?
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 (β=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 (β=0.16±0.02, p<0.001), i.e. the poor were less likely to doctor-shop. Both waiting time (β=0.12±0.02, p<0.001) and doctor-shopping (β=0.37±0.02, p<0.001) were significantly related to non-attendance. Our findings suggest a highly equitable specialist ambulatory care public system in Hong Kong. Health care resources are appropriately targeted at the socially indigent, and the poor are not discriminated against and pushed to seek alternative sources of care by the system. These results should be confirmed using a prospective design. © 2005 Elsevier Ltd. All rights reserved.
Persistent Identifierhttp://hdl.handle.net/10722/86882
ISSN
2015 Impact Factor: 2.814
2015 SCImago Journal Rankings: 1.894
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorJohnston, JMen_HK
dc.contributor.authorLeung, Gen_HK
dc.contributor.authorSaing, Hen_HK
dc.contributor.authorKwok, KOen_HK
dc.contributor.authorHo, LMen_HK
dc.contributor.authorWong, IOLen_HK
dc.contributor.authorTin, KYKen_HK
dc.date.accessioned2010-09-06T09:22:29Z-
dc.date.available2010-09-06T09:22:29Z-
dc.date.issued2006en_HK
dc.identifier.citationSocial Science And Medicine, 2006, v. 62 n. 10, p. 2551-2564en_HK
dc.identifier.issn0277-9536en_HK
dc.identifier.urihttp://hdl.handle.net/10722/86882-
dc.description.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 (β=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 (β=0.16±0.02, p<0.001), i.e. the poor were less likely to doctor-shop. Both waiting time (β=0.12±0.02, p<0.001) and doctor-shopping (β=0.37±0.02, p<0.001) were significantly related to non-attendance. Our findings suggest a highly equitable specialist ambulatory care public system in Hong Kong. Health care resources are appropriately targeted at the socially indigent, and the poor are not discriminated against and pushed to seek alternative sources of care by the system. These results should be confirmed using a prospective design. © 2005 Elsevier Ltd. All rights reserved.en_HK
dc.languageengen_HK
dc.publisherPergamon. The Journal's web site is located at http://www.elsevier.com/locate/socscimeden_HK
dc.relation.ispartofSocial Science and Medicineen_HK
dc.subjectAccess to careen_HK
dc.subjectHong Kongen_HK
dc.subjectHorizontal equityen_HK
dc.subjectNon-attendanceen_HK
dc.subjectSocio-economic statusen_HK
dc.subject.meshAmbulatory Care Facilitiesen_HK
dc.subject.meshDatabases as Topicen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHealth Services Accessibilityen_HK
dc.subject.meshHong Kongen_HK
dc.subject.meshHospital Administrationen_HK
dc.subject.meshHumansen_HK
dc.subject.meshInterviews as Topicen_HK
dc.subject.meshMaleen_HK
dc.subject.meshPatient Acceptance of Health Careen_HK
dc.subject.meshPublic Sectoren_HK
dc.subject.meshReferral and Consultationen_HK
dc.subject.meshSocial Classen_HK
dc.subject.meshWaiting Listsen_HK
dc.titleNon-attendance and effective equity of access at four public specialist outpatient centers in Hong Kongen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0277-9536&volume=62&spage=2551&epage=2564&date=2006&atitle=Non-attendance+and+effective+equity+of+access+at+four+public+specialist+outpatient+centers+in+Hong+Kongen_HK
dc.identifier.emailJohnston, JM: jjohnsto@hku.hken_HK
dc.identifier.emailLeung, G: gmleung@hkucc.hku.hken_HK
dc.identifier.emailHo, LM: lmho@hkucc.hku.hken_HK
dc.identifier.emailWong, IOL: iolwong@hku.hken_HK
dc.identifier.emailTin, KYK: tinyiukei@hkucc.hku.hken_HK
dc.identifier.authorityJohnston, JM=rp00375en_HK
dc.identifier.authorityLeung, G=rp00460en_HK
dc.identifier.authorityHo, LM=rp00360en_HK
dc.identifier.authorityWong, IOL=rp01806en_HK
dc.identifier.authorityTin, KYK=rp00494en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.socscimed.2005.10.036en_HK
dc.identifier.pmid16305815-
dc.identifier.scopuseid_2-s2.0-33645066364en_HK
dc.identifier.hkuros118708en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-33645066364&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume62en_HK
dc.identifier.issue10en_HK
dc.identifier.spage2551en_HK
dc.identifier.epage2564en_HK
dc.identifier.isiWOS:000237499200018-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridJohnston, JM=7403397964en_HK
dc.identifier.scopusauthoridLeung, G=7007159841en_HK
dc.identifier.scopusauthoridSaing, H=12786815100en_HK
dc.identifier.scopusauthoridKwok, KO=44161211700en_HK
dc.identifier.scopusauthoridHo, LM=7402955625en_HK
dc.identifier.scopusauthoridWong, IOL=7102513940en_HK
dc.identifier.scopusauthoridTin, KYK=7003796897en_HK

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