Lai Angel Hor-Yan, Kuang Zoey, Yam Carrie Ho-Kwan, Ayub Shereen, Yeoh Eng-Kiong
Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong.
Department of Applied Social Science, Hong Kong Polytechnic University, Kowloon Tong, Hong Kong.
Health Soc Care Community. 2018 May;26(3):374-382. doi: 10.1111/hsc.12523. Epub 2017 Dec 11.
Considering the ageing population in economically advanced regions across the world, measures are necessary to enhance the health of the older population as well as contain public healthcare spending. Hong Kong implements the Elderly Health Care Voucher Scheme (EHCVS), providing older people aged 65 or above an annual subsidy of visiting private healthcare service providers for chronic disease prevention and management. The services also aim at reallocating demand from the public to private sector as well as improve quality of services. This qualitative study explored the experiences of EHCVS recipients (n = 55, aged 61-94) with eight focus group interviews in Hong Kong in the year 2016. Convenience sampling was used. Research questions were: (1) Why do older people choose not to use EHCVS for preventive as well as disease management services among older people in Hong Kong? (2) What are the barriers to reallocating demand from the public to private sector? (3) In what ways did EHCVS improve the quality of primary care services for older people? Using a deductive and inductive approach, eight qualitative themes were identified. Findings suggested that the non-targeted services and inadequate knowledge on EHCVS deterred older people from using the vouchers for disease management and prevention. The relatively expensive private services, lack of trust in the private sector, low public clinic fees and good services quality of the public sector, together with inadequate private practitioners in the healthcare market were barriers that hinder demand reallocation. Nevertheless, the quality of primary care services had been improved after the implementation of EHCVS with shortened wait times and opportunities to discuss health-related issues with private practitioners. Findings were discussed with practice, policy and research implications.
鉴于全球经济发达地区的人口老龄化，采取措施来增进老年人口的健康并控制公共医疗支出是很有必要的。香港实施了长者医疗券计划（EHCVS），为65岁及以上的老年人提供年度补贴，用于支付拜访私家医疗服务提供者以进行慢性病预防和管理的费用。这些服务还旨在将需求从公共部门重新分配到私营部门，并提高服务质量。这项定性研究在2016年通过在香港进行八次焦点小组访谈，探索了长者医疗券计划受惠者（n = 55，年龄在61 - 94岁之间）的经历。采用了便利抽样。研究问题如下：（1）在香港的老年人中，为什么有些人选择不使用长者医疗券进行预防性和疾病管理服务？（2）将需求从公共部门重新分配到私营部门的障碍是什么？（3）长者医疗券计划以何种方式提高了老年人初级保健服务的质量？运用演绎和归纳的方法，确定了八个定性主题。研究结果表明，非针对性的服务以及对长者医疗券计划的了解不足，阻碍了老年人使用医疗券进行疾病管理和预防。相对昂贵的私家服务、对私营部门缺乏信任、公立诊所费用低廉且服务质量良好，再加上医疗市场中私家医生不足，这些都是阻碍需求重新分配的障碍。尽管如此，长者医疗券计划实施后，初级保健服务的质量得到了改善，候诊时间缩短，并且有机会与私家医生讨论健康相关问题。研究结果还结合实践、政策和研究意义进行了讨论。
