Choice Of Health Facility Research Articles

Choice of health-care facility after introduction of free essential health services in Nepal.

Choice of health-care services depends on patients' characteristics and the features of health-care facilities available. In Nepal, a significant proportion of health care is provided through the private sector, despite the introduction of free essential health care for all citizens in 2008. We sought to determine whether people chose private or public facilities in the first instance for acute health problems. We also assessed the reasons for their choice. A cross-sectional survey was done by use of a questionnaire administered to 400 household heads in Jhapa district, Nepal. 272 (68%) respondents sought treatment from public health-care facilities in the first instance. On adjusted analysis, illiterate people were more likely to choose public facilities than people with higher secondary education (OR 5.47, P = 0.002). Similarly, lower-caste and religious-minority respondents were more likely to choose public facilities than disadvantaged janajati (OR 2.33, P = 0.01). Among respondents who used public facilities, 174 (64.0%) and 109 (40.0%) stated that that their choice was based on financial accessibility and physical accessibility, respectively. Among respondents who used private facilities, 65 (50.7%) and 54 (42.1%) said their choice was based on adequacy of resources/services and health-care delivery, respectively. A substantial portion of respondents used public health-care facilities in the first instance, mainly because of financial and physical accessibility rather than adequacy of resources or better health-care delivery. These results may indicate a positive impact of removal of user fees for public health-care facilities in Nepal, especially for impoverished people.

Geographical, Health Systems’ and Sociocultural Patterns of Tb/Hiv Co- Infected Patients’ Health Seeking Behavior in a Conflict Affected Setting: The Case of Eastern Democratic Republic of Congo

Background: The Democratic Republic of Congo (DRC) is one of the high burden TB countries. The country has been affected by a political conflict for more than 15 years now. HIV prevalence has been increasing in the country too. Detection and care of TB/HIV co-infected cases is a major problem in the country. Aim: This study aimed at describing patterns of health seeking behaviors among patients with TB/HIV regarding their choice of health facilities for integrated TB/HIV care in the Goma and surrounding health districts. Methods: The methods used included a cross-sectional descriptive survey with TB/HIV co-infected patients and qualitative interviews of health workers. Results: The study found that geographical residence did not play a major role in choice of facility for care by patients infected with TB and HIV. Many patients shun facilities which are close and seek care relatively far away. Instead of geographical proximity, availability of drugs and welcoming attitudes determined the choice of integrated care facilities. Also, fear for discrimination and stigmatization in the community result into patients in this area concealing their infection; rather, they claim being victim of empoisoning. Conclusion: Sustained decentralization of integrated TB/HIV services through better programs’ coordination and community involvement to address misconceptions about TB and HIV and stigmatization are essential to promote uptake of TB/HIV services and retain patients in treatment.

Women's perspective of maternity care in Cambodia

Consideration of the needs of pregnant women and their ability and willingness to attend maternal services and pay for them is central to the provision of accessible and acceptable maternal care. Women's satisfaction with maternal services is poorly understood in many developing countries, including Cambodia in South East Asia. The objective of this study was to investigate women's perceptions and experiences of private and public skilled birth attendants, including midwives, during childbirth in Cambodia. A qualitative design using a naturalistic inquiry approach was undertaken to seek sensitive personal issue. Thirty individual in-depth interviews were conducted with women who had recently given birth at private and public health facilities in one province in Cambodia. Data were analysed using a thematic approach. Women's choice of health facility was influenced by their perceptions of safety and staff attitudes. Reported barriers to the effective utilisation of public maternity services were costs associated with the birth, staff attitudes and a lack of supportive care during labour and in the postpartum period. Although private health care is more expensive than public health care, some women reported a preference for private birth attendants as they perceived them to provide safer and more supportive care in labour. Women expect, but do not always receive humane, professional, supportive and respectful treatment from public skilled birth attendants. While the removal of unexpected costs and geographical barriers are important to increasing public maternity care and service utilisation, improvements in maternity services should focus on addressing provider attitudes and enhancing communication skills during labour, birth and the immediate postpartum period.

Which health care facilities do adult malawian antiretroviral therapy patients utilize during intercurrent illness? a cross sectional study

BackgroundAntiretroviral therapy (ART) clinic populations have expanded enormously in the successful Malawi ART scale-up programme. Overcrowding, long waiting times and living far away from the clinic may affect the extent to which patients use their ART clinic for intercurrent illnesses.MethodsWe interviewed patients of a large urban ART clinic in Blantyre, Malawi, during routine visits about the choice of health care facility during recent illness episodes.ResultsOut of 346 enrolled adults, mean age 39.8 (range 18-70) years, 54.3% female, 202 (58%) reported one or more illness in the past 6 months, during which 85 (42.1%; 95%-confidence interval: 36.9-47.3%) did not utilize their own clinic. Long distance to the clinic was the main subjective reason, while low education attainment, rural residence, perceived mild illness and dissatisfaction with the ART service were associated with not using their own clinic in multivariate analyses. Of all participants, 83.6% were satisfied with the service provided; only 6.1% were aware of the full service package of the ART clinic.ConclusionsART patients often seek health care outside their own clinic, which may have detrimental effects, and has consequences for ART counseling content and reporting of ART information in health passports.

Preferred Choice of Health Facilities for Healthcare among Adult Residents in Ilorin Metropolis, Kwara State, Nigeria

Purpose: The choice of health facilities for healthcare by an individual is largely determined by several factors. This study aims to determine predictors of preferred choice of health facility for care. Methods: In a descriptive cross-sectional study, pre-tested semi-structure questionnaire was administered to 366 adults selected through a multi-stage sampling technique in Ilorin metropolis. Data collected were analysed using Epi Info software version 3.4.1 and level of significance set at p < 0.05. Results: The preferred health facility for medical care was private hospitals (35.2%) followed by pharmaceutical store (27.9%) and 17.0% for general/teaching hospitals and only 12.3% for primary health care (PHC). Quick service and availability of drugs were the major reasons for their preference which were said to be better in private hospitals. Sex, marital status, educational status, occupation and city area where the respondents dwell are all associated with the preferred choice of health facility for care. Conclusion: This study has shown that the private sector is preferred to the public ones with regards to receiving healthcare and that within the public sector, the higher levels of health facilities are preferred to the primary health care centres. Improving the image and performance of the public health facilities especially the PHC is very important for appropriate utilization of health services Keywords: Preference, Health Facilities, Public hospital, Private hospital

Application of Frequent Itemsets Mining to Analyze Patterns of One-Stop Visits in Taiwan

BackgroundThe free choice of health care facilities without limitations on frequency of visits within the National Health Insurance in Taiwan gives rise to not only a high number of annual ambulatory visits per capita but also a unique “one-stop shopping”phenomenon, which refers to a patient' visits to several specialties of the same healthcare facility in one day. The visits to multiple physicians would increase the potential risk of polypharmacy. The aim of this study was to analyze the frequency and patterns of one-stop visits in Taiwan.Methodology/Principal FindingsThe claims datasets of 1 million nationally representative people within Taiwan's National Health Insurance in 2005 were used to calculate the number of patients with one-stop visits. The frequent itemsets mining was applied to compute the combination patterns of specialties in the one-stop visits. Among the total 13,682,469 ambulatory care visits in 2005, one-stop visits occurred 144,132 times and involved 296,822 visits (2.2% of all visits) by 66,294 (6.6%) persons. People tended to have this behavior with age and the percentage reached 27.5% (5,662 in 20,579) in the age group ≥80 years. In general, women were more likely to have one-stop visits than men (7.2% vs. 6.0%). Internal medicine plus ophthalmology was the most frequent combination with a visited frequency of 3,552 times (2.5%), followed by cardiology plus neurology with 3,183 times (2.2%). The most frequent three-specialty combination, cardiology plus neurology and gastroenterology, occurred only 111 times.Conclusions/SignificanceWithout the novel computational technique, it would be hardly possible to analyze the extremely diverse combination patterns of specialties in one-stop visits. The results of the study could provide useful information either for the hospital manager to set up integrated services or for the policymaker to rebuild the health care system.

Factors of primary care demand: a case study

Primary care facilities in many parts of Quebec, Canada, are under pressure because of staff shortages, service instability, increasing requests from an aging population, and uncoordinated, fragmented delivery of care. Resource allocation in one facility is often made with an approximate knowledge of its impact on other facilities nearby. Unanticipated overflows may affect patients' health and staff morale. The main purpose of this study was to use consolidated administrative data in order to find the factors that better explain the choice of patients in Val Saint-Francois, a rural area of Quebec. Administrative data relating to medical visits were linked to 6 primary care facilities over a period of 4 years. A classification tree algorithm generated users' profiles of facility choice, which was explored for frequency of use and related changes in preference, and for changes in levels of service. The factors used were: age, sex, postal c ode, and date of visit. Community was the major explanatory factor for patients' choice of facility, probably reflecting a tendency to use the closest facility. Older men and women tended to use appointment-based clinics more regularly than those who were younger. It was noted that younger men selected emergency rooms more often than young women, with the difference cancelling out as they age. The classification tree determined age thresholds for changing behaviours but also found dates when profiles changed within the same age-sex group. Later examination of service levels revealed that profile changes were subsequent to modifications in service operating hours. Evidence was found that predisposing factors (age and sex) with community enabling factors (distance) affected people's choice of healthcare facility. Changes in some patients' profiles corresponded to changes in service levels, proving that a modification of service hours in one facility affects demand in other facilities in a way that can be quantified. It is important to measure the effect of service changes on patients' choices for a more efficient allocation of resources.

Entitlements to health care: Why is there a preference for private facilities among poorer residents of Chennai, India?

This paper examines access to health care by poorer residents in Chennai, India. It reveals constraining and enabling conditions for impoverished users seeking treatment. We explore patterns of health-seeking behaviour through the reasoning of residents themselves as well as stakeholders involved in providing care for these users. Particular attention is paid to the needy residents' preference for private health care providers despite the costs involved and that free public facilities are available. We address this issue by combining Sen's entitlement approach with Penchansky and Thomas' work on access to health care. Based on data gathered in a qualitative field-based research design including interviews with 14 residents and 58 stakeholders involved in caring for poor people, we argue that the availability of health care facilities within walking distance is a necessary but not sufficient precondition for satisfactory access. Rather, we demonstrate the influence of 'entitlements to health care' which allow poor households that are endowed with resources such as income, knowledge and social networks to realise access. The narratives we present reveal not only experiences of health care, but also feelings about its utilisation. The latter, we contend, are crucial in determining choice of health care facilities. This finding suggests that analyses of affordability and physical access to health care in less developed countries should include a focus on emotional dimensions of utilisation. In other words, there is a need to consider not only effective access to health care, but also affective dimensions of treatment for poorer citizens.

HEALTH FACILITY CHOICE IN HIV- AND AIDS-AFFECTED HOUSEHOLDS IN TWO SOUTH AFRICAN COMMUNITIES

This paper analysed differences in the choice of health-care facility by ill individuals in human immunodeficiency virus (HIV)- and acquired immune deficiency syndrome (AIDS)-affected households in the Free State province of South Africa. Secondary education, access to medical aid and household income were significant determinants of choice as were severity and type of illness, and type of health care required. Ill persons with HIV- and AIDS-related illnesses are significantly more likely to opt for public health care, although the strength of this preference declines as household income increases. Those with severe and particularly severe HIV- and AIDS-related illness, in turn, are significantly more likely to opt for private health care, especially at higher levels of income. The public health care sector therefore is likely to remain the backbone of health-care provision to those infected with and affected by HIV and AIDS, highlighting the need for equitable access to efficient, quality public health services.

Health care utilisation under the 30-Baht Scheme among the urban poor in Mitrapap slum, Khon Kaen, Thailand: a cross-sectional study.

BackgroundIn 2001, the Government of Thailand introduced a universal coverage scheme with the aim of ensuring equitable health care access for even the poorest citizens. For a flat user fee of 30 Baht per consultation, or for free for those falling into exemption categories, every scheme participant may access registered health services. The exemption categories include children under 12 years of age, senior citizens aged 60 years and over, the very poor, and volunteer health workers. The functioning of these exemption mechanisms and the effect of the scheme on health service utilisation among the poor is controversial.MethodsThis cross-sectional study investigated the prevalence of 30-Baht Scheme registration and subsequent self-reported health service utilisation among an urban poor population in the Teparuk community within the Mitrapap slum in Khon Kaen city, northeastern Thailand. Furthermore, the effectiveness of the exemption mechanisms in reaching the very poor and the elderly was examined. Factors for users' choice of health facilities were identified.ResultsOverall, the proportion of the Teparuk community enrolled with the 30-Baht Scheme was high at 86%, with over one quarter of these exempted from paying the consultation fee. User fee exemption was significantly more frequent among households with an above-poverty-line income (64.7%) compared to those below the poverty line (35.3%), χ2 (df) = 5.251 (1); p-value = 0.018. In addition, one third of respondents over 60 years of age were found to be still paying user fees. Self-reported use of registered medical facilities in case of illness was stated to be predominantly due to the service being available through the scheme, with service quality not a chief consideration. Overall consumer satisfaction was high, especially among those not required to pay the 30 Baht user fee.ConclusionWhilst the 30-Baht Scheme seems to cover most of the poor population of Mitrapap slum in Khon Kaen, the user fee exemption mechanism only works partially with regard to reaching the poorest and exempting senior citizens. Service utilisation and satisfaction are highest amongst those who are fee-exempt. Service quality was not an important factor influencing choice of health facility. Ways should be sought to improve the effectiveness of the current exemption mechanisms.

Global Outsourcing of Healthcare: A Medical Tourism Decision Model

The demand for global healthcare services is experiencing tremendous growth. US patients are seeking to reduce their expenditures on healthcare through obtaining treatment on an internationally competitive basis. This trend, known as medical tourism, is on the rise, and US legislators and policy makers must be aware of the issues facing American patients. This paper seeks to model factors that influence a patient’s decision to seek healthcare services abroad. We develop a two-stage model for medical tourism - the first stage being the evaluation of the foreign country and the second stage choosing the healthcare facility. We argue country-specific characteristics influence the country of choice - including economic conditions, political climate, and regulatory policies. We also argue that certain factors - including costs, hospital accreditation, quality of care, and physician training - impact the choice of healthcare facility. The model suggests that no one factor is dominant in the decision, but all play a crucial role in choosing healthcare on an international basis. Policy makers must use these factors to evaluate the impact medical tourism will continue to have on the US healthcare system in order to effectively compete in today’s global, consumer-driven healthcare market.

Responding to Crisis: Patterns of Health Care Utilization in Central Kenya Amid Economic Decline

Abstract: African states have become increasingly unable to provide adequate health care to their citizens due to debt, structural adjustment, poverty, and mismanagement. The health crisis is worsening in many areas and driving up mortality rates after decades of decline. This article investigates how African communities and their citizens respond in light of state inability to deliver health-related services. Drawing on a survey of more than five hundred rural Kenyans, our analysis shows that people are dissatisfied with government facilities and are turning to mission clinics and hospitals as well as to private clinics. A number of factors determine choice of health-care facility, including cost, level of education, socioeconomic background, the time taken to reach a facility, the type of disease requiring treatment, and agro-ecological zones. These findings have profound theoretical implications for health and development models, which normally are biased in favor of developed Western countries. Resume: A cause de la dette, de l'ajustement structurel, de la pauvrete et d'une mauvaise gestion, les etats africains sont devenus de plus en plus incapables d'offrir une couverture medicale adequate a leurs citoyens. La crise de la sante s'aggrave dans de nombreuses regions et fait grimper les taux de mortalite apres des annees de regression. Cet article examine comment les communautes africaines et leurs citoyens reagissent au vu de l'incapacite de l'etat a leur offrir des services lies a la sante. En s'inspirant d'une enquete effectuee sur plus de cinq cent Kenyans ruraux, notre analyse montre que la population n'est pas satisfaite des structures offertes par le gouvernement et qu'elle se tourne vers les cliniques et hopitaux de mission ainsi que vers les cliniques privees. Un nombre de facteurs determine le choix de ces structures medicales, comme par exemple le cout, le niveau d'instruction, le milieu socio-economique, le temps necessaire pour atteindre une structure, le type de maladie a traiter, et les zones agro-ecologiques. Ces resultats ont de profondes implications theoriques sur les modeles de sante et de developpement qui d'habitude sont influences en faveur des pays occidentaux developpes. Introduction It is an unfortunate reality that the world region most in need of health care is least able to provide it. African states-burdened by debt, structural adjustment, poverty, and poor governance-are increasingly unable to allocate resources to combat the leading killers across the continent: pneumonia, diarrheal diseases, measles, malaria, and now HIV/AIDS. The health crisis is worsening in many areas and driving up mortality rates after decades of decline. This leads to a simple but important question: How do African communities and their citizens respond when states have less capacity to deliver health services? Several responses are possible. People may rely on home treatment, they may seek out nongovernment facilities, they may turn to traditional healers, or they may opt for private clinics. These options are influenced by a wide variety of individual arid community characteristics such as income, seriousness of the disease, cost of treatment, and some additional factors that are unique to developing societies. In fact, few studies have examined the sociological determinants of changing patterns of health care utilization amid economic decline. This limits our knowledge and encourages the use of inappropriate theoretical models. In response, this paper addresses these issues by reporting the results of a comprehensive and representative survey of over five hundred rural Kenyans from the central part of the country in 1995. The survey is important for a number of reasons. It ascertains the illnesses and diseases that afflict people, determines how they respond to sickness, and measures how satisfied (or dissatisfied) they are with several health-care alternatives. Moreover, it reports various economic, social, community, and cultural factors that help condition individual decision-making in health care. …

African traditional healers and outcome-contingent contracts in health care

Even with the expansion of modern medicine, African traditional healers remain popular. This paper advances an economic perspective of healers to contribute to an explanation of this phenomenon. An important element of their practice has previously been ignored: healers use and are able to enforce outcome-contingent contracts. This, in turn, allows them to credibly deliver high quality care. Data on patient choice of health facility from Cameroun shows that patients choose healers over modern facilities for reasons that can be directly traced to the advantages inherent in the use of outcome-contingent contracts.

Bypassing Health Centres in Tanzania: Revealed Preferences for Quality

When patients bypass one health facility to seek care at another, strong preferences are revealed. The patterns of bypassing observed in Iringa Rural district in Tanzania show evidence of patients' understanding of various measures of quality at the facilities that they visit and bypass. We match two data sets that measured quality in health facilities with a sample of patient choice of health facilities. We use a conditional logit regression on patient choice of provider to show the relationship between patient behaviour and objective measures of technical quality in the health facilities. The paper shows that patients seek facilities that provide high quality consultations and prescriptions, are staffed by more knowledgeable physicians, and are better stocked with basic supplies. Patients avoid facilities that use injections too liberally or over‐prescribe medication. Furthermore, the patterns differ significantly by illness condition and show evidence that patients understand the relative importance of these qualities for the condition from which they suffer.

The Culture of Male Supremacy and Emergency Obstetric Care: The Nigerian Experience

The maternal mortality ratio in Nigeria remains one of the highest in the world (WHO, 1990). Many intervention programs in this area have failed to achieve the desired purpose because efforts have been mainly in the area of hospital care or service delivery, without due cognisance being given to the androcentric behaviour which affects maternal roles, especially the dynamics of decision-making when emergency obstetric care service becomes necessary, Using findings from a recently concluded study, the paper looks at the impact of the culture of male gender supremacy on women's reproductive rights and their total well-being. It explores the gender myths about pregnancy, and pregnancy outcomes, and the central role played by men in emergency obstetric conditions. The study. which is an action-oriented study, was carried out in South-western Nigeria, by a multi-disciplinary research group, using a variety of data collection techniques – questionnaire survey, in-depth interview, Focus Group Discussions, direct observation, and exposure to educative materials – posters, talks/discussions, films, drama etc, Study findings showed that androcentric behaviour is a major determinant of pregnancy outcome, since men have almost absolute control over the choice of health care facilities used during pregnancy, the condition under which delivery takes place, diet during pregnancy, and the types of action taken in emergency obstetric conditions. Yet, the study found that most men lacked knowledge of what constitutes emergency obstetric conditions, appropriate actions to be taken, and a shallow knowledge of pregnancy, fertility and family planning. The study instituted an intervention program which was aimed at improving the knowledge of men in what constitutes emergency obstetric care. and also counselling on androcentric behaviours which may be detrimental to pregnancy outcomes, and the social dynamics of what constitutes a healthy family. (The African Anthropologist: 2002 9 (2): 157-182)

The Use of Random Utility in Modeling Rural Health Care Demand: Discussion

that are quality-differentiated, close substitutes. The three papers in this session take advantage of this modeling strategy in the context of health care facility choice, so as to shed light on the impact of rural hospital closings on the welfare of rural populations. Each of the three papers is of interest in its own right, but all three illustrate that many of the same problems that plague recreation demand applications emerge in this new application-albeit sometimes for different rea-

Health-care facility choice and the phenomenon of bypassing.

Health policy-makers in developing countries are often disturbed and to a degree surprised by the phenomenon of the ill travelling past a free or subsidized local public clinic (or other public facility) to get to an alternative source of care at which they often pay a considerable amount for health care. That a person bypasses a facility is almost certainly indicative either of significant problems with the quality of care at the bypassed facility or of significantly better care at the alternative source of care chosen. When it is a poor person choosing to bypass a free public facility and pay for care further away, such action is especially bothersome to public policy-makers. This paper uses a unique data set, with a health facility survey in which all health facilities are identified, surveyed, and located geographically; and a household survey in which a sample of households from the same health district is also both surveyed and located geographically. The data are analyzed to examine patterns of health care choice related to the characteristics and locations of both the facilities and actual and potential clients. Rather than using the distance travelled or some other general choice of type of care variable as the dependent variable, we are able actually to analyze which specific facilities are bypassed and which chosen. The findings are instructive. That bypassing behaviour is not very different across income groups is certainly noteworthy, as is the fact that the more severely ill tend to bypass and to travel further for care than do the less severely ill. In multivariate analysis almost all characteristics of both providers and facilities are found to have the a priori expected relationships to facility choice. Prices tend to deter use, and improved quality of services to increase the likelihood of a facility being chosen. The answer to the bypassing dilemma seems to be for providers to provide as good quality care relative to the money charged (if any), as other, often further away, providers.

Determinants of help-seeking behaviour in cases of epilepsy attending a teaching hospital in India: an indigenous explanatory model.

Psychosocial factors determining the choice of health facility in 30 cases of epilepsy attending the psychiatric outpatient department (OPD) of a teaching (referral) hospital in India were studied. The majority of those who chose indigenous healers as their first contact treatment facility did so on the decision of the family. A belief in the supernatural causation of epilepsy combined with family decision was associated with the choice of indigenous health facility. Belief in the physical cause of epilepsy and the participation of social network in decision making were, on the other hand, closely associated with the choice of practitioners of modern medicine. The time-lag between onset of illness and first contact for treatment was short when indigenous healers were consulted first, however these patients usually took a long time to reach the referral centre when they passed through the indigenous healers.

A Consumer Preference Approach to the Planning of Rural Primary Health-Care Facilities

A problem in planning the expansion of a rural primary health-care delivery system is to determine the set of facilities to be added to an existing system so as to maximize the incremental benefit to the community subject to a cost constraint. The proposed approach involves the following five steps: (1) identification of facility attributes relevant to patients in their choice of health-care facilities, (2) modeling of an individual's overall preference for alternate facilities as a weighted linear function of these facility attributes, (3) transformation of each consumer's preference model into a benefit function expressing the individual's benefit in dollars/year for an existing or potential facility, (4) provision of a method for determining the total incremental benefit to the community from a set of proposed health-care facilities, and (5) use of a heuristic procedure to determine a set of facilities that yields near-optimum total incremental benefit subject to the cost constraint. A practical application of the proposed approach reveals that the consumer preference model has substantial reliability and predictive validity.