Patients' experience with the Hong Kong healthcare system : a comparison between South Asian ethnic minority and Chinese people

Abstract

Ethnic minorities across the globe encounter disparities in healthcare. A great deal of research has been conducted on the disparities in the experiences of ethnic minority patients in Western countries. However, such knowledge has still been lacking in the Eastern world. This knowledge is extremely important in Asia, where recently many places are becoming increasingly multiethnic and multicultural. Comparing both the out-patient and in-patient healthcare experiences of minority patients with those of ethnic majority people may provide valuable insight into the challenges and experiences they face in accessing and utilizing the services. Hong Kong is a multiethnic society, with 8% of the population from a diverse range of ethnic minority groups, of which South Asians form the largest. Although a few studies have indicated disparities in health status between ethnic minorities and the majority Chinese population, not enough attention has been given to the health status and experiences of South Asian patients in Hong Kong. Therefore, in this thesis I aimed to 1) understand the experiences of South Asian patients in accessing healthcare services, particularly women being more vulnerable; 2) explore the perceptions of and challenges faced by healthcare professionals in the provision of culturally appropriate care to South Asian patients; 3) compare the perceived health system responsiveness, hospital experience and health-related quality of life of South Asian patients with those of local Chinese people; and 4) identify the effect of patient experience on health-related quality of life. I employed a mixed-method approach, comprising both qualitative and quantitative methods. First I conducted focus group discussions with 30 South Asian women and interviews with 22 healthcare professionals (doctors, nurses and pharmacists). I also conducted a cross-sectional survey with 575 South Asian and 494 Chinese people using WHO health system responsiveness, Picker patient experience (PPE-15) and Veteran Rand 12-item (VR-12) questionnaires. The overarching theme identified was ‘disengagement between South Asian women and the healthcare system’, which forms the key challenge for them to access healthcare in Hong Kong. “Missing support” at the healthcare system level and “dysfunctional relationship with South Asian patients” at the interpersonal level were identified as the challenges of healthcare professionals in providing care to South Asian patients. When compared with the Chinese participants in the cross-sectional study, South Asians reported to perceive significantly lower health system responsiveness for out-patient and in-patient services (2.3% and 8.2% lower, respectively), along with 10.8% more problematic experiences in hospitals. Their perceived health-related quality of life was also significantly lower 3% than Chinese participants. I also identified that patient experience is associated with health-related quality of life. Our results demonstrated the need to enhance both the accessibility for South Asians patients to appropriate healthcare-related information and culturally informed patient–provider interaction. Healthcare professionals demonstrated their need for proper education and training in cultural competency, in order to improve the provision of intercultural care. Concerted efforts are required to improve the existing healthcare system for ethnic minority users, such as engaging South Asian patients as partners in their treatment through a patient-centered communication approach.