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

Janice M. Johnston, Gabriel Leung, Hnin Saing, Kin-On Kwok, Lai-Ming Ho, Irene O.L. Wong and Keith Y.K. Tin

Social Science & Medicine, 2006, vol. 62, issue 10, 2551-2564

Abstract: 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

Keywords: Non-attendance; Horizontal; equity; Socio-economic; status; Hong; Kong; Access; to; care (search for similar items in EconPapers)
Date: 2006
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Citations: View citations in EconPapers (3)

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