Supply-demand and income-integrated perspectives of healthcare accessibility in high-density, transit-oriented cities

• Combines supply–demand-based and income-integrated measures in a dual-accessibility framework. • Both measures reveal an urban–new town–rural accessibility gradient and within-tier heterogeneity. • Integrating both accessibility outcomes identifies distinct patterns of convergences and divergences. • Transport connectivity and socio-economic characteristics are jointly associated with these convergences and divergences. • Provides policies to align healthcare provision with income-sensitive transport support. Despite Hong Kong’s high-density, transit-oriented setting, healthcare-seeking travel burdens are disproportionate for low-income residents and accumulate with recurrent visits. This study addresses the limitations of traditional supply–demand-based healthcare accessibility by combining the Gaussian three-step floating catchment area method with an income-integrated accessibility measure that captures income-heterogeneous travel burdens. This framework addresses two questions: where integrated accessibility outcomes converge or diverge, and how transport-related built environment and socio-economic characteristics correlate with these patterns. The main findings are: (i) convergence clusters in the urban core and rural areas, whereas divergence concentrates in low-income, inner-city areas, affluent urban fringe, and well-connected new towns; (ii) MNL analyses show convergence arises where healthcare supply, transit connectivity, and income reinforce each other, while divergence arises where service distribution is misaligned with transport-related built environment and income levels. These findings demonstrate that healthcare planning should coordinate facility distribution with income-sensitive transport policies to address the accessibility mismatch.