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

Author

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

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

Suggested Citation

  • Johnston, Janice M. & Leung, Gabriel & Saing, Hnin & Kwok, Kin-On & Ho, Lai-Ming & Wong, Irene O.L. & Tin, Keith Y.K., 2006. "Non-attendance and effective equity of access at four public specialist outpatient centers in Hong Kong," Social Science & Medicine, Elsevier, vol. 62(10), pages 2551-2564, May.
    • Handle: RePEc:eee:socmed:v:62:y:2006:i:10:p:2551-2564
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    References listed on IDEAS

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    6. Arnesen, Kjell E. & Erikssen, Jan & Stavem, Knut, 2002. "Gender and socioeconomic status as determinants of waiting time for inpatient surgery in a system with implicit queue management," Health Policy, Elsevier, vol. 62(3), pages 329-341, December.
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    Cited by:

    1. 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.
    2. Chee Hon Chan & Ho Kit Wong & Paul Siu Fai Yip, 2017. "Associations of relative income deprivation with perceived happiness and self-rated health among the Hong Kong Chinese population," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 62(6), pages 697-707, July.
    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.

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