Understanding the perceptions on the availability and accessibility of public health services for the poor and socially disadvantaged. A qualitative study in Hong Kong

Background 8% of the population reports inability to financially afford primary care despite the universal healthcare policy in Hong Kong. This study aims to understand the multifactorial causes that contribute to the healthcare accessibility barriers. Methods Individual telephone interviews were conducted in 2020 on a group of participants from a previous study that identified themselves as unable to financially afford primary care. A total of 13 participants were interviewed. Results A thematic analysis, through the socioecological model, revealed four levels of factors that contributed to the participant’s healthcare inaccessibility: intrapersonal and interpersonal, institutional, community, and policy. The first level relates to the (1a) limited choice of outpatient care due to wealth status, (1b) inadequate knowledge of types and number of services provided, (1c) high non-monetary opportunity costs in seeking public healthcare services, (1d) reluctance to seek medical care unless the situation becomes serious and acute, and (1e) consumerist attitude and perception of quality of care received. The second level relates to (2a) price increase of public A&E departments, (2b) high price of private healthcare providers, (2c) inadequate General Out-Patient Clinics, (2d) complex steps to access General Out-Patient Clinics, (2e) unmet medical needs received from public healthcare services, (2f) inadequate employer support for ill employees, and (2g) inadequate public support for patients struggling with dental issues. The third level relates to (3a) insufficient support for patients struggling with physically accessing General Out-Patient Clinics. The fourth level relates to (4a) inadequate Elderly Health Care Voucher and (4b) inadequate Comprehensive Social Security Assistance (CSSA) and its exclusive requirements. Conclusion These findings increase our understanding of the patients’ barriers when accessing primary care. The data highlights the need for a multifactorial approach when attempting to achieve primary health care and to eliminate financial barriers completely for patients living in and around the poverty line.