Barriers to preventive care utilization among Hong Kong community-dwelling older people and their views on using financial incentives to improve preventive care utilization

Qiuyan Liao, Wingyan Lau, Sarah McGhee, Maurice Yap, Rita Sum, Jun Liang, Jinxiao Lian, Qiuyan Liao, Wingyan Lau, Sarah McGhee, Maurice Yap, Rita Sum, Jun Liang, Jinxiao Lian

Abstract

Background: Financial incentive is increasingly used as a mean to promote preventive care utilization (PCU), but the current Elderly Health Care Voucher Scheme (EHCVS) in Hong Kong is ineffective for encouraging PCU.

Objective: To explore the older people's barriers to PCU and their views on financial incentive, including EHCVS, for improving private PCU.

Design and setting: Focus-group discussions were conducted in community elderly centres located in five districts of Hong Kong.

Participants: Community-dwelling older people aged 60 years or above.

Results: Lack of understanding about preventive care and low awareness of the need for preventive care were key factors for the low motivation for PCU. Uncertainty over the level of service fee charged and concerns over service quality hindered the choice of using the private service providers under the current EHCVS. Financial incentives specific for preventive care services were thought to be cues to actions and guides for service promotion. However, some flexibility in service coverage and a set time limit of the financial incentives were preferred to accommodate individual needs.

Conclusions: Apart from promoting knowledge of preventive care, official monitoring for service fee and quality is important for empowering older people to choose private service providers for preventive care. Financial incentives for preventive care services should be more specific to cue service promotion and uptake of preventive care while maintaining flexibility to accommodate individual needs.

Patient or public contribution: Participants were recruited using purposive sampling with the coordination of community elderly centres. Data were analysed using thematic coding.

Keywords: barrier; financial incentive; older people; preventive care; qualitative study.

Conflict of interest statement

The authors declare they have no conflict of interest.

© 2021 The Authors. Health Expectations published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Research themes relating to barriers to using preventive care services provided by private primary care practitioners among older people
FIGURE 2
FIGURE 2
Research themes relating to views on financial incentives for preventive care

References

    1. Global health and aging. World Health Organization. . Published 2011. Accessed December 6, 2019.
    1. Hong Kong population projections: 2015‐2064. Census and Statistics Department of The Government of the Hong Kong Special Administrative Region. . Published 2015. Accessed December 6, 2019.
    1. World report on aging and health. World Health Organization. . Published 2015. Accessed February 21, 2020.
    1. Tian WH, Chen CS, Liu TC. The demand for preventive care services and its relationship with inpatient services. Health Policy. 2010;94(2):164‐174. 10.1016/j.healthpol.2009.09.012
    1. Chen CS, Peng YI, Lee PC, Liu TC. The effectiveness of preventive care at reducing curative care risk for the Taiwanese elderly under National Health Insurance. Health Policy. 2015;119(6):787‐793. 10.1016/j.healthpol.2015.01.004
    1. Preventive Care for Older Adults: Module on Health Assessment: Chapter 1 ‐ Importance of health assessment. Primary Healthcare Office of Food and Health Bureau of The Government of the Hong Kong Special Administrative Region. . Published 2019. Accessed December 24, 2020.
    1. Report of Population Health Survey 2014/15. Centre for Health Protection of Department of Health of The Government of the Hong Kong Special Administrative Region. . Published 2017. Accessed January 5, 2020.
    1. NHS Health Check Programme, Patients Recorded as Attending and Not Attending, 2012‐13 to 2017‐18: Summary tables Version 3. NHS Digital. . Published 2019. Accessed December 24, 2020.
    1. Economic Modelling For Vascular Checks. Department of Health. Published 2008. Accessed November 23, 2020.
    1. Mytton OT, Jackson C, Steinacher A, et al. The current and potential health benefits of the National Health Service Health Check cardiovascular disease prevention programme in England: A microsimulation study. PLoS Med. 2018;15(3):e1002517. 10.1371/journal.pmed.1002517
    1. Report of the strategic review on healthcare manpower planning and professional development: Chapter 1 Hong Kong Healthcare Systems and Healthcare Professionals. Food and Health Bureau of The Government of the Hong Kong Special Administrative Region. . Published 2018. Accessed December 2, 2019.
    1. Fees and Charges. Hospital Authority of The Government of the Hong Kong Special Administrative Region. . Published 2017. Accessed November 20, 2020.
    1. Thematic household survey report ‐ Report No. 68. Census and Statistics Department of The Government of the Hong Kong Special Administrative Region. . Published November 14, 2019. Accessed January 12, 2020.
    1. My Health My Choice Healthcare Reform Second Stage Consultation Document: Appendix C: Hong Kong’s Current Private Healthcare Sector. Food and Health Bureau of The Government of the Hong Kong Special Administrative Region. . Published 2010. Accessed December 29, 2020.
    1. Background of Elderly Health Care Voucher Scheme . Health Care Voucher of The Government of the Hong Kong Special Administrative Region. . Published 2008. Accessed January 4, 2020.
    1. Lai AH, Kuang Z, Yam CH, Ayub S, Yeoh EK. Vouchers for primary healthcare services in an ageing world? The perspectives of elderly voucher recipients in Hong Kong. Health Soc Care Community. 2018;26(3):374‐382. 10.1111/hsc.12523
    1. Yam CHK, Wong ELY, Fung VLH, Griffiths SM, Yeoh EK. What is the long term impact of voucher scheme on primary care? Findings from a repeated cross sectional study using propensity score matching. BMC Health Serv Res. 2019;19(1):875. 10.1186/s12913-019-4707-8
    1. Primary Care Directory . Food and Health Bureau of The Department of Health of The Government of the Hong Kong Special Administrative Region. . Published 2020. Accessed December 29, 2020.
    1. Hennink MM, Kaiser BN, Weber MB. What influences saturation? Estimating sample sizes in focus group research. Qual Health Res. 2019;29(10):1483‐1496. 10.1177/1049732318821692
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77‐101. 10.1191/1478088706qp063oa
    1. Banerjee M, Capozzoli M, McSweeney L, Sinha D. Beyond kappa: a review of interrater agreement measures. Can J Stat. 1999;27(1):3‐23. 10.2307/3315487
    1. Leech NL, Onwuegbuzie AJ. Beyond constant comparison qualitative data analysis: Using NVivo. Sch Psychol Q. 2011;26(1):70‐84. 10.1037/a0022711
    1. Adams J, Bateman B, Becker F, et al. Effectiveness and acceptability of parental financial incentives and quasi‐mandatory schemes for increasing uptake of vaccinations in preschool children: systematic review, qualitative study and discrete choice experiment. Health Technol Assess. 2015;19(94):1‐176. 10.3310/hta19940
    1. Becker F, Anokye N, de Bekker‐Grob EW, et al. Women's preferences for alternative financial incentive schemes for breastfeeding: A discrete choice experiment. PLoS One. 2018;13(4):e0194231. 10.1371/journal.pone.0194231
    1. Farooqui MA, Tan YT, Bilger M, Finkelstein EA. Effects of financial incentives on motivating physical activity among older adults: results from a discrete choice experiment. BMC Public Health. 2014;14:141. 10.1186/1471-2458-14-141
    1. Giles EL, Becker F, Ternent L, Sniehotta FF, McColl E, Adams J. Acceptability of financial incentives for health behaviours: a discrete choice experiment. PLoS One. 2016;11(6):e0157403. 10.1371/journal.pone.0157403
    1. Marti J, Bachhuber M, Feingold J, Meads D, Richards M, Hennessy S. Financial incentives to discontinue long‐term benzodiazepine use: a discrete choice experiment investigating patient preferences and willingness to participate. BMJ Open. 2017;7(10):e016229. 10.1136/bmjopen-2017-016229
    1. Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. Milbank Q. 2005;83(4): 10.1111/j.1468-0009.2005.00428.x
    1. Van Doorslaer E, Clarke P, Savage E, Hall J. Horizontal inequities in Australia's mixed public/private health care system. Health Policy. 2008;86(1):97‐108. 10.1016/j.healthpol.2007.09.018
    1. Rana RH, Alam K, Gow J. Selection of private or public hospital care: examining the care‐seeking behaviour of patients with private health insurance. BMC Health Serv Res. 2020;20(1):380. 10.1186/s12913-020-05253-y
    1. Yam HK, Mercer SW, Wong LY, Chan WK, Yeoh EK. Public and private healthcare services utilization by non‐institutional elderly in Hong Kong: is the inverse care law operating? Health Policy. 2009;91(3):229‐238. 10.1016/j.healthpol.2008.12.012
    1. Levy BR, Myers LM. Preventive health behaviors influenced by self‐perceptions of aging. Prev Med. 2004;39(3):625‐629. 10.1016/j.ypmed.2004.02.029
    1. Liu S, Yam CH, Huang OH, Griffiths SM. Willingness to pay for private primary care services in Hong Kong: are elderly ready to move from the public sector? Health Policy Plan. 2013;28(7):717‐729. 10.1093/heapol/czs112

Source: PubMed

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