Health system responsiveness in Hong Kong: a comparison between South Asian and Chinese patients' experiences

Objectives: Health system responsiveness is related to the way and the environment in which individuals are treated during their health system interaction. Generally, patients who are members of ethnic minority (EM) groups encounter more challenges in receiving healthcare services and bear a disproportionate burden of diseases compared with most counterparts. We aimed to compare the health system responsiveness perceived by South Asian (SA) EM people with that of local Chinese people in Hong Kong.

Study design: The cross-sectional survey sample comprised 575 SA and 494 Chinese individuals. The health system responsiveness module of the World Health Survey 2002 was used for data collection.

Methods: We used propensity score weighting method to balance the two groups. Simple and multiple regressions were used to compare the perceived outpatient and inpatient health system responsiveness between SA and Chinese participants, respectively, before and after adjustment for demographics. All estimates were accompanied by 95% confidence intervals, and two-sided tests were conducted with significance concluded by a P value < 0∙05.

Results: Compared with the Chinese participants, the SA participants reported generally lower health system responsiveness for outpatient and inpatient services. The top three mean score difference (SA-Chinese) for outpatient care included autonomy (-0.78, P < 0.001), communication (-0.67, P < 0.001), and choice (-0.53, P < 0.001), and the top three mean score difference for inpatient care included communication (-0.90, P < 0.001), autonomy (-0.82, P < 0.001), and choice (-0.61, P < 0.01). In addition, SA participants also experienced lower responsiveness in access to community support (-0.81, P < 0.001) during hospitalization but perceived higher quality of basic amenities (0.29, P < 0.001) and confidentiality (0.44, P < 0.01) in outpatient settings.

Conclusion: SA participants in an urbanized Chinese-oriented society reported generally lower health system responsiveness compared with the local Chinese group; however, SA participants perceived higher confidentiality and quality of basic amenities in their outpatient experience. Concerted efforts from healthcare providers and policymakers are required to improve the existing healthcare system for users of members of EM groups.