Can voucher scheme enhance primary care provision for older adults: cross-sectional study in Hong Kong

BMC Geriatrics

Johnny T. K. Cheung¹  Eric K. P. Lee²  Eliza L. Y. Wong²  Samuel Y.S. Wong²  Patsy Y. K. Chau²  Lawrence H. F. Luk²  Benjamin H. K. Yip²  E. K. Yeoh²  Dexing Zhang²  Dicken C. C. Chan² 

[1] Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong;JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong;

关键词: Incentive;    Preventive care;    Continuity of care;    Public private partnership;   

DOI  :  10.1186/s12877-020-01851-x

来源: Springer

【 摘 要 】

BackgroundThe Hong Kong government has launched the Elderly Health Care Voucher (EHCV) scheme to facilitate primary care in the private sector for older adults. This study aimed to examine whether voucher use was associated with a shift of healthcare burden from the public to the private sector, vaccine uptake and continuity of care.MethodsThis cross-sectional survey recruited older adults with ≥3 chronic diseases through convenience sampling from seven general outpatient clinics, seven geriatric day hospitals, and five specialist outpatient clinics of the public healthcare sector in Hong Kong. We used multiple logistic regression to address the study objective.ResultsA total of 1032 patients participated in the survey. We included 714 participants aged 70 or above in the analysis. EHCV use was associated with higher utilization of private primary care services, including general practitioner and family doctor (Adjusted Odds Ratio (AOR) 2.67, 95% Confidence Interval (95%CI) 1.51–4.72) and Chinese medicine clinic (AOR 3.53, 95%CI 1.47–8.49). There were no significant associations of EHCV use with public general outpatient clinic attendance, Accident & Emergency attendance, and hospitalization. Furthermore, EHCV users were more likely to receive pneumococcal vaccination (AOR 2.17, 95%CI 1.22–3.85) and were less likely to visit the same doctors for chronic disease management (AOR 0.10, 95%CI 0.01–0.73).ConclusionsWhile the EHCV may promote private primary care utilization and preventive care, older patients continue to rely on public services and the EHCV may worsen continuity of care. Policy-makers should designate voucher usage for chronic disease management and continuity of care.

【 授权许可】

CC BY