Spatiotemporal patterns of accessibility and inequality in Hong Kong’s public and private healthcare system: A ten-year longitudinal study

Abstract

The unequal sharing of healthcare resources between different socioeconomic groups can lead to worsened health outcomes, financial strains for low-income individuals, and broader social and economic issues. While the link between healthcare service accessibility and socioeconomic factors has been widely explored, the spatiotemporal evidence based on government-funded and self-funded healthcare facilities remains limited. Focusing on public and private services is crucial for ensuring efficient and equitable healthcare for diverse social strata. Drawing on the representative travel data from the Travel Characteristics Survey (TCS), this study employed the enhanced two-step floating catchment area (E2SFCA) method and Gini index to assess the spatiotemporal patterns of healthcare accessibility and inequality in Hong Kong, including public hospitals, public general outpatient clinics, private hospitals, and private clinics. The geographically and temporally weighted regression (GTWR) model was used to unravel the spatiotemporal patterns of socioeconomic inequalities in healthcare accessibility. We found that (1) in high-complexity healthcare services (i.e., hospitals), accessibility to government-funded hospitals was higher than to self-funded ones, while in primary services (i.e., clinics), the opposite was true; (2) there was significant spatial autocorrelation in healthcare accessibility in Hong Kong, and the high-high and low-low clusters of high-complexity medical facilities shrunk over time; (3) in downtown areas, the positive correlation between median household income, the older population ratio, and healthcare accessibility shifted to negative, and the negative correlation between population density and healthcare accessibility strengthened. These findings may inform policymakers in implementing effective strategies for increasing the accessibility and equality of healthcare services.

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