Background Providing equitable access to health care is a goal for most health systems. The long-term and costly nature of treating non-communicable diseases may present particular challenges for equity of access (equal treatment for equal need), though few previous studies have considered this. This study compares equity of access to health care in Scotland and Hong Kong, with a particular focus on treatment for non-communicable diseases (NCDs). Since Scotland’s health care is largely tax-funded, while Hong Kong has a mixed medical economy (shared between public and private sectors) we expected to see greater equity of access to health care in Scotland, particularly for treatment of NCDs.
Methods In two large, population-representative household surveys - the Scottish Health Survey (2008–9) and Hong Kong’s Thematic Household Survey (2010) - we assessed associations between health care utilisation (GP consultations, specialist consultations, admissions to hospital, and utilisation specifically for NCDs) and socioeconomic position (income, occupation and education) using multi-variable logistic regression. We also controlled for ‘need for health care’ (age, sex, self-rated health and chronic conditions).
Results After controlling for need, in Scotland: utilisation of GP consultations and GP consultations for cardiovascular disease (CVD) were not associated with any measure of SEP; utilisation of specialist care, however, was positively associated with income (OR 1.27 for highest versus lowest income quintile, 95% CI 1.08 – 1.50), though this was attenuated by additionally adjusting for education, and the association was even stronger for specialist CVD consultations (OR 1.68, 95% CI 1.12 – 2.54); and hospital admissions were negatively associated with income (OR 0.73, 95% CI 0.57 – 0.94). In Hong Kong, utilisation of all types of health care was positively associated with income and occupation, except for care for chronic conditions; most associations were attenuated after additionally controlling for health insurance cover.
Conclusion Taking utilisation rates as a proxy for access to health care, our results suggest that in Scotland, access to primary care is highly equitable, but that people on low incomes or with poor education may have restricted access to specialist treatment, especially for CVD. This could be due to GP referrals giving preference to higher SEP patients. Surprisingly, we found that, whilst access to care in Hong Kong was generally better for people with high SEP, treatment of chronic conditions was more equitable than in Scotland, showing that fully tax-funded health systems do not necessarily provide more equitable access to all forms of care than systems of mixed funding.
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