Health Service Utilization in Hong Kong During the COVID-19 Pandemic – A Cross-sectional Public Survey

Abstract

Background: As health systems across the world respond to the coronavirus disease 2019 (COVID-19), there is rising concern that patients without COVID-19 are not receiving timely emergency care, resulting in avoidable deaths. This study examined patterns of self-reported health service utilization, their socio-demographic determinants and association with avoidable deaths during the COVID-19 outbreak. Methods: A cross-sectional telephone survey was conducted between March 22 and April 1, 2020, during the peak rise in confirmed COVID-19 cases in Hong Kong. Cantonese-speaking Hong Kong residents over 18-years-old were recruited using a computerised random digital dialling (RDD) system. The RDD method used stratified random sampling to ensure a representative sample of the target population by age, gender, and residential district. A structured self-reported questionnaire was used. Results: Out of 1738 placed calls, 765 subjects responded to the questionnaire (44.0% response rate). The factors associated with avoiding medical consultation included being female (37.2% vs. 22.5%, P<.001), married (32.8% vs. 27%, P=.044), completing tertiary education (35.3% vs. 27.7% (secondary) vs. 14.8% (primary), P=.005), and those who reported a "large/very large" impact of COVID-19 on their mental health (36.1% vs 30.5% (neutral) vs. 19.7% (very small/small), P=.047) using logistic regression analysis. Conclusion: Married females with both higher educational attainment and concern about COVID-19 were associated with avoiding healthcare services. Timely public communication to encourage and promote early health seeking treatment even during extreme events such as pandemics are needed.

Avoidance of Healthcare Utilization in South Korea during the Coronavirus Disease 2019 (COVID-19) Pandemic

“…Women, older people, those with a lower income level, and those living in highly affected residential areas were more likely to avoid healthcare utilization than other groups were. These results are similar to prior research investigating the association between social determinants and healthcare avoidance during public health emergencies such as epidemic outbreaks [ 18 , 23 , 27 ]. Therefore, the avoidance of behaviors of subpopulation members during a pandemic warrant the attention of health policy officers and public health authorities.…”

“…A critical challenge is to determine how healthcare agencies should respond to changes in healthcare utilization and possible barriers to access healthcare facilities for the public created by the COVID-19 outbreak. Moreover, the lessons learned from the MERS experience in Korea [ 6 ] and other countries demonstrate the importance of understanding the community response [ 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. To our knowledge, no other study has evaluated the impact of COVID-19 on the demand of healthcare utilization among the general population.…”

Effect of COVID-19 pandemic on provision of sexual and reproductive health services in primary health facilities in Nigeria: a cross-sectional study

“…The distribution of the PHCs by State is presented in Table 1. The PHCs were selected from 30 LGAs, three per state, with all being rural or semi-urban, and urban. The shortfall was in Borno State where 20 instead of 32 PHCs were accessed, due to the ongoing insurgency which has reduced movements to many health facilities in the state.…”

Cost-effectiveness of a Telemonitoring Program for Patients With Heart Failure During the COVID-19 Pandemic in Hong Kong: Model Development and Data Analysis

“…The percentage of achieved adherence was assumed to be 80% based on a study investigating the patient adherence of a smartphone-based telemonitoring system for HF [ 22 ]. The percentage of medical avoidance among patients with HF (26.1%) was approximated from a public survey of 765 subjects on the use of health services during the COVID-19 pandemic in Hong Kong [ 11 ]. The base-case value of health care avoidance duration was estimated to be 1.5 years with a range of 0.5-2 years, based upon the epidemiologic projections of the COVID-19 pandemic [ 23 ].…”

“…COVID-19 has not only disrupted the provision of routine medical care but has also caused patients to delay and avoid seeking medical care [ 10 ]. COVID-19 was reported to be a factor associated with avoiding medical consultation in Hong Kong [ 11 ]. Patients with chronic conditions such as HF are therefore at risk of suboptimal care during the COVID-19 pandemic as a result of disruption or avoidance of routine medical care.…”