Socioeconomic Gradients in Healthcare Access and Health-Seeking Behavior in Hong Kong

Abstract

Introduction: Limited healthcare accessibility and lower health-seeking behaviour have been shown to contribute to poor health in low-income families. Given that Hong Kong has heavily-subsidized public healthcare-services, it is unclear as to whether differences in healthcare access and health-seeking behaviour exist across different socioeconomic groups. The purpose of this systematic review is to synthesize the literature on the socioeconomic gradients of access to healthcare-services and health-seeking behaviour in Hong Kong. Methodology: Original pieces of research conducted in Hong Kong that examined low-income populations and assessed healthservice accessibility and health-seeking behaviour were eligible for inclusion. Three electronic databases (PubMed, Scopus and PsycINFO) were searched using keywords: (1)‘low-income’, ‘poverty’, or ‘socioeconomic’, (2)‘Hong Kong’ and (3) ‘health-service access’, ‘health-service utilization’ or ‘health-seeking behaviour’. PRISMA guidelines were followed. Results: 121 articles were identified, 35 studies were screened, and 6 were included. Overall, in Hong Kong, there is horizontal inequity with pro-rich bias in private primary care outweighing the pro-poor bias of public care. The quality of primary care experienced was higher for those with higher income and private insurance and were able to pay out-of-pocket. Cervical and breast cancer detection are also much later in low-income or ethnic minority women. Almost half had never received a cervical smear before, which delayed their opportunity for earlier treatment and better prognosis. Last, lower household income and education level were associated with less frequent health information seeking, which makes individuals less aware of methods to improve their health. Conclusions: There is socioeconomic inequity in health-seeking behaviour and access to healthcare services, which is most likely related to the private-dominated primary-care system. Affordable, holistic and community-based primary care should be made more accessible to low-income families. This will be an essential step to improving healthcare service accessibility and health-seeking behaviour in low-income families, in order to reduce health inequities in Hong Kong.