Beyond financial access: socioeconomic and ethnic disparities in preventive care engagement under Singapore’s Healthier SG programme

Abstract Background Voluntary empanelment is widely adopted as a primary care strategy across diverse health systems to promote continuity of care and early disease detection, yet its equity implications remain underexplored, particularly in Asian multi-ethnic settings. Singapore’s Healthier SG, launched in 2023, promotes voluntary empanelment with a general practice (GP) clinic or polyclinic to enhance preventive care, including screenings and vaccinations. Initially targeting adults aged ≥ 60 years, eligibility expanded to those aged ≥ 40 years from late 2023. Despite these efforts, how demographic and socio-economic factors shape engagement from programme awareness to screening remains poorly understood. Aim To examine demographic and socio-economic factors associated with engagement stages in Healthier SG, using Andersen’s Behavioural Model of Health Services Utilisation. Method We analysed data from the Singapore Population Health Studies ( N = 3,899; aged ≥ 40). Engagement was classified into four stages: (1) unaware and not enrolled (reference), (2) aware but not enrolled, (3) enrolled but not screened, and (4) enrolled and screened. Multinomial logistic regression examined associations with predisposing, enabling, and need factors, estimating odds ratios and marginal effects (predicted probabilities). Results Half of respondents (50.5%) were unaware of Healthier SG, while 36.1% had enrolled or completed at least one screening. Older age, higher education, retirement, and higher level of housing were associated with greater odds of enrolment and screening. Enrolment was lower among Indian respondents after socio-economic adjustment, while Malay respondents showed higher odds of awareness without enrolment. Higher chronic disease burden was associated with screening completion among those enrolled, but not with enrolment. Conclusion Despite universal eligibility and the subsidisation of preventive services, socio-economic and ethnic disparities persist across engagement stages. These findings suggest that equitable engagement under voluntary empanelment requires targeted outreach, streamlined enrolment, and culturally responsive communication, beyond the elimination of cost alone. Longitudinal research is required to assess whether early engagement gaps translate into longer-term health disparities.