Patients’ socioeconomic status and their evaluations of primary care in Hong Kong

Onikepe Owolabi,Xiaolin Wei,Haitao Li,Samuel Ys Wong,Nan Yang,Zhenzhen Zhang,Sian M Griffiths,Winnie Yip,Martin Cs Wong

doi:10.1186/1472-6963-13-487

Abstract

BackgroundStrengthening primary care is key to Hong Kong’s ongoing health system reform. Primary care remains unregulated, private sector dominated and financed mainly out-of-pocket. This study sought to examine the association between patients’ socioeconomic status (SES), source of health payments and the quality of primary care they accessed to inform policy discussions.MethodsData was collected from 1,994 respondents in a stratified random telephone survey with a 68% response rate, using the validated primary care assessment tool (PCAT). Education, household-income and type of housing were selected as indicators of SES. Multivariable ordinal logistic regression models were created to examine associations between indicators of SES and scores of quality.ResultsHigher household-income was most significantly associated with better experiences of quality. Respondents with HK$ 15000–39999 (USD1934-5158) and HK$ 40000 (USD5159) and above were 47% (OR 1.47, 95% CI 1.10-1.96) and 2 times (OR 2.07, 95% CI 1.38-3.09) more likely to experience better quality than the lowest-income group respectively. Income group HK$ 40000 (USD5159) and above was 84% more likely to have better utilization (OR 1.84, 95% CI (1.21-2.78), and 2 times more likely to receive better comprehensiveness (OR 1.90, 95% CI 1.26-2.87). Patients who used only private insurance were 80% (OR 1.80, 95% CI 1.20-2.68) more likely to experience better quality than those who paid out-of-pocket.ConclusionsOur results show that the quality of primary care experienced in HK tended to be higher for those who had higher income and private insurance, and were able to pay out-of-pocket for the care. This indicated that the inequality in primary care is likely to be related with the private dominated primary care system in Hong Kong. More public responsibility on primary health care should be sought for in HK and similar contexts to reduce the inequality in primary care.

Highlights

Strengthening primary care is key to Hong Kong’s ongoing health system reform
The primary care provider within this tool was defined using the 3 questions asked in the original primary care assessment tool (PCAT) survey- “is there a doctor that you usually go to if you’re sick and need advice about your health?” “Is there a doctor that knows you best as a person?” and “Is there a doctor or place that is most responsible for your health care?” We examined data to see what proportion of respondents had the same provider for 2 or 3 of these questions to understand how clearly they defined their primary care provider
We aimed to obtain 2000 completed surveys to detect a mean difference in the overall primary care score of 0.5 between the users of public and private providers, at an alpha level of 0.005, and power of 80% allowing for a 70% response rate

Summary

Introduction

Strengthening primary care is key to Hong Kong’s ongoing health system reform. The attributes of primary care have been used to develop measurement scales by researchers [5] These attributes have been found to be associated with quality of care [6,7] and are the most relevant characteristics of effective primary care organization and delivery at the population level. They are: 1) First contact access to care; 2) ongoing care; 3) Comprehensiveness of care; and 4) Coordination of care [1,8]

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Discussion

Conclusion