IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v91y2009i3p229-238.html
   My bibliography  Save this article

Public and private healthcare services utilization by non-institutional elderly in Hong Kong: Is the inverse care law operating?

Author

Listed:
  • Yam, Ho-Kwan
  • Mercer, Stewart W.
  • Wong, Lai-Yi
  • Chan, Wan-Kin
  • Yeoh, Eng-Kiong

Abstract

Objectives To assess the factors associated with healthcare services utilization by the non-institutional elderly across five types of service utilization (Western medicine doctors in Government clinics, private Western medicine doctors, Chinese medicine practitioners, Emergency Units, and hospitalization).Methods A secondary data analysis of a territory-wide cross-sectional survey collected by the Government among a representative sample of 4812 elderly (aged 60 and above) in Hong Kong.Results Our analysis, based on Anderson's behavioral framework, shows that need factors (relating to actual or perceived illness and diseases) are significantly related to the healthcare services utilization examined. However, enabling factors, such as monthly household income per capita, play a significant role in determining the utilization. Although the lower-income elderly consult more Government clinics and less private clinics than the more affluent, they have a lower total utilization of healthcare services despite having significantly greater healthcare needs.Conclusions This suggests a mismatch of need and supply within the mixed economy of private and public healthcare services and suggests the existence of an 'inverse care law' in Hong Kong amongst elderly citizens. The findings raise concerns of inequities in Hong Kong's healthcare system, raising implications for future healthcare reforms.

Suggested Citation

  • Yam, Ho-Kwan & Mercer, Stewart W. & Wong, Lai-Yi & Chan, Wan-Kin & Yeoh, Eng-Kiong, 2009. "Public and private healthcare services utilization by non-institutional elderly in Hong Kong: Is the inverse care law operating?," Health Policy, Elsevier, vol. 91(3), pages 229-238, August.
    • Handle: RePEc:eee:hepoli:v:91:y:2009:i:3:p:229-238
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0168-8510(08)00292-3
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Morris, Stephen & Sutton, Matthew & Gravelle, Hugh, 2005. "Inequity and inequality in the use of health care in England: an empirical investigation," Social Science & Medicine, Elsevier, vol. 60(6), pages 1251-1266, March.
    2. Newbold, K. Bruce & Eyles, John & Birch, Stephen, 1995. "Equity in health care: Methodological contributions to the analysis of hospital utilization within Canada," Social Science & Medicine, Elsevier, vol. 40(9), pages 1181-1192, May.
    3. Gabriel M. Leung & Keith Y. K. Tin & Owen O'Donnell, 2009. "Redistribution or horizontal equity in Hong Kong's mixed public–private health system: a policy conundrum," Health Economics, John Wiley & Sons, Ltd., vol. 18(1), pages 37-54, January.
    4. Fernandez-Olano, C. & Hidalgo, J.D. Lopez-Torres & Cerda-Diaz, R. & Requena-Gallego, M. & Sanchez-Castano, C. & Urbistondo-Cascales, L. & Otero-Puime, A., 2006. "Factors associated with health care utilization by the elderly in a public health care system," Health Policy, Elsevier, vol. 75(2), pages 131-139, January.
    5. de Boer, Angela G. E. M. & Wijker, Wouter & de Haes, Hanneke C. J. M., 1997. "Predictors of health care utilization in the chronically ill: a review of the literature," Health Policy, Elsevier, vol. 42(2), pages 101-115, November.
    6. Chou, K. L. & Chi, I., 2004. "Factors associated with the use of publicly funded services by Hong Kong Chinese older adults," Social Science & Medicine, Elsevier, vol. 58(6), pages 1025-1035, March.
    7. Leung, Gabriel M. & O.L. Wong, Irene & Chan, Wai-Sum & Choi, Sarah & Lo, Su-Vui, 2005. "The ecology of health care in Hong Kong," Social Science & Medicine, Elsevier, vol. 61(3), pages 577-590, August.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Mozhaeva, Irina, 2022. "Inequalities in utilization of institutional care among older people in Estonia," Health Policy, Elsevier, vol. 126(7), pages 704-714.
    2. He, Alex Jingwei & Tang, Vivien F.Y., 2021. "Integration of health services for the elderly in Asia: A scoping review of Hong Kong, Singapore, Malaysia, Indonesia," Health Policy, Elsevier, vol. 125(3), pages 351-362.
    3. Yeoh, Eng-Kiong & Yam, Carrie H.K. & Chong, Ka-Chun & Chow, Tsz-Yu & Fung, Valerie L.H. & Wong, Eliza L.Y. & Griffiths, Sian M., 2020. "An evaluation of universal vouchers as a demand-side subsidy to change primary care utilization: A retrospective analysis of longitudinal services utilisation and voucher claims data from a survey coh," Health Policy, Elsevier, vol. 124(2), pages 189-198.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Paulos Teckle & Matt Sutton, 2008. "How Do the Determinants of Demand for GP Visits Respond to Higher Supply? An Analysis of Grouped Counts," Swiss Journal of Economics and Statistics (SJES), Swiss Society of Economics and Statistics (SSES), vol. 144(III), pages 495-513, September.
    2. Man Jiang & Guang Yang & Lvying Fang & Jin Wan & Yinghua Yang & Ying Wang, 2018. "Factors associated with healthcare utilization among community-dwelling elderly in Shanghai, China," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-22, December.
    3. Crespo-Cebada, Eva & Urbanos-Garrido, Rosa M., 2012. "Equity and equality in the use of GP services for elderly people: The Spanish case," Health Policy, Elsevier, vol. 104(2), pages 193-199.
    4. Fichera, Eleonora & Emsley, Richard & Sutton, Matt, 2016. "Is treatment “intensity” associated with healthier lifestyle choices? An application of the dose response function," Economics & Human Biology, Elsevier, vol. 23(C), pages 149-163.
    5. Luo, Juhua & Zhang, Xiulan & Jin, Chenggang & Wang, Dongmin, 2009. "Inequality of access to health care among the urban elderly in northwestern China," Health Policy, Elsevier, vol. 93(2-3), pages 111-117, December.
    6. Philip Q. Yang & Shann Hwa Hwang, 2016. "Explaining Immigrant Health Service Utilization," SAGE Open, , vol. 6(2), pages 21582440166, May.
    7. Eric French & Elaine Kelly & Richard Cookson & Carol Propper & Miqdad Asaria & Rosalind Raine, 2016. "Socio‐Economic Inequalities in Health Care in England," Fiscal Studies, Institute for Fiscal Studies, vol. 37, pages 371-403, September.
    8. Hoeck, Sarah & François, Guido & Van der Heyden, Johan & Geerts, Joanna & Van Hal, Guido, 2011. "Healthcare utilisation among the Belgian elderly in relation to their socio-economic status," Health Policy, Elsevier, vol. 99(2), pages 174-182, February.
    9. Wong, Irene O.L. & Cowling, Benjamin J. & Lo, Su-Vui & Leung, Gabriel M., 2009. "A multilevel analysis of the effects of neighbourhood income inequality on individual self-rated health in Hong Kong," Social Science & Medicine, Elsevier, vol. 68(1), pages 124-132, January.
    10. Martin Wong & Michael Leung & Caroline Tsang & S. Lo & Sian Griffiths, 2013. "The rising tide of diabetes mellitus in a Chinese population: a population-based household survey on 121,895 persons," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 58(2), pages 269-276, April.
    11. Heather Conde & James Ted McDonald, 2007. "The Health Services Use Among Older Canadians in Rural and Urban Areas," Social and Economic Dimensions of an Aging Population Research Papers 178, McMaster University.
    12. Fanny Janssen & Anthe van den Hende & Joop de Beer & Leo van Wissen, 2016. "Sigma and beta convergence in regional mortality: A case study of the Netherlands," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 35(4), pages 81-116.
    13. Tavares, Lara Patrício & Zantomio, Francesca, 2017. "Inequity in healthcare use among older people after 2008: The case of southern European countries," Health Policy, Elsevier, vol. 121(10), pages 1063-1071.
    14. Han, Kyu-Tae & Park, Eun-Cheol & Kim, Sun Jung, 2016. "Unmet healthcare needs and community health center utilization among the low-income population based on a nationwide community health survey," Health Policy, Elsevier, vol. 120(6), pages 630-637.
    15. Denzil G. Fiebig & Kees van Gool & Jane Hall & Chunzhou Mu, 2021. "Health care use in response to health shocks: Does socio‐economic status matter?," Health Economics, John Wiley & Sons, Ltd., vol. 30(12), pages 3032-3050, December.
    16. Coast, Joanna, 2018. "A history that goes hand in hand: Reflections on the development of health economics and the role played by Social Science & Medicine, 1967–2017," Social Science & Medicine, Elsevier, vol. 196(C), pages 227-232.
    17. Jiménez-Rubio, Dolores & Hernández-Quevedo, Cristina, 2010. "Explaining the demand for pharmaceuticals in Spain: Are there differences in drug consumption between foreigners and the Spanish population?," Health Policy, Elsevier, vol. 97(2-3), pages 217-224, October.
    18. Walter Beckert & Elaine Kelly, 2021. "Divided by choice? For‐profit providers, patient choice and mechanisms of patient sorting in the English National Health Service," Health Economics, John Wiley & Sons, Ltd., vol. 30(4), pages 820-839, April.
    19. David Cantarero-Prieto & Marta Pascual-Sáez & Carla Blázquez-Fernández, 2021. "Does Social Isolation Affect Medical Doctor Visits? New Evidence Among European Older Adults," Applied Research in Quality of Life, Springer;International Society for Quality-of-Life Studies, vol. 16(2), pages 787-804, April.
    20. Gao, Qiuming & Wang, Derek, 2021. "Hospital efficiency and equity in health care delivery: A study based in China," Socio-Economic Planning Sciences, Elsevier, vol. 76(C).

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:91:y:2009:i:3:p:229-238. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.