Health Economics, Policy and Law


Access to primary care in Hong Kong, Greater London and New York City

Pui Hing Chaua1 c1, Jean Wooa2, Michael K. Gusmanoa3a4, Daniel Weisza5, Victor G. Rodwina6 and Kam Che Chana7

a1 Research Assistant Professor, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China

a2 Professor, Faculty of Medicine, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China

a3 Associate Professor, New York Medical College, USA

a4 Research Scholar, Hastings Center, USA

a5 Associate Research Scientist, World Cities Project, International Longevity Center, Mailman School of Public Health, Columbia University, New York, USA

a6 Professor, Robert F. Wagner Graduate School of Public Service, New York University, New York, USA

a7 Senior Research Assistant, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China


We investigate avoidable hospital conditions (AHC) in three world cities as a way to assess access to primary care. Residents of Hong Kong are healthier than their counterparts in Greater London or New York City. In contrast to their counterparts in New York City, residents of both Greater London and Hong Kong face no financial barriers to an extensive public hospital system. We compare residence-based hospital discharge rates for AHC, by age cohorts, in these cities and find that New York City has higher rates than Hong Kong and Greater London. Hong Kong has the lowest hospital discharge rates for AHC among the population 15–64, but its rates are nearly as high as those in New York City among the population 65 and over. Our findings suggest that in contrast to Greater London, older residents in Hong Kong and New York face significant barriers in accessing primary care. In all three cities, people living in lower socioeconomic status neighborhoods are more likely to be hospitalized for an AHC, but neighborhood inequalities are greater in Hong Kong and New York than in Greater London.

(Online publication May 01 2012)