Public and private healthcare services utilization by non-institutional elderly in Hong Kong: is the inverse care law operating?
OBJECTIVE
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.
Yam
Ho-Kwan
HK
Centre for Systems for Health, School of Public Health, The Chinese University of Hong Kong, Hong Kong. carrieyam@cuhk.edu.hk
Mercer
Stewart W
SW
Wong
Lai-Yi
LY
Chan
Wan-Kin
WK
Yeoh
Eng-Kiong
EK
D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006723:Hong Kong; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D017149:Private Sector; D017150:Public Sector