Choice Of Health Facility Research Articles

Social capital, outpatient care utilization and choice between different levels of health facilities in rural and urban areas of Bhutan

This study examines the factors that explain outpatient care utilization and the choice between different levels of health facilities in Bhutan, focusing on individual social capital, given Bhutan's geography of remote and sparsely populated areas. The more isolated the living, the more important individual social capital may become. Standard factors proposed by the Andersen model of healthcare utilization serve as control variables. Data for 2526 households from the 2012 Bhutan Living Standards Survey, which contains a social capital module covering structural, cognitive and output dimensions of social capital, are used. The results from the logistic regression analysis show that individual social capital is positively related with the probability of seeking treatment when ill or injured. Informal social contacts and perceived help and support are most important in rural areas, whereas specific trust matters in urban areas. The explanatory power of the model using a subset of the data for urban areas only, however, is very low as most predisposing and enabling factors are insignificant, which is not surprising though in view of better access to health facilities in urban areas and the fact that healthcare is provided free of charge in Bhutan. Multinomial regression results further show that structural and output dimensions of social capital influence the likelihood of seeking care at secondary or tertiary care facilities relative to primary care facilities. Moreover, economic status and place of residence are significantly associated with healthcare utilization and choice of health facility. The findings with respect to social capital suggest that strategizing and organizing social capital may help improve healthcare utilization in Bhutan.

Comparison of patient perceived primary care quality in public clinics, public hospitals and private clinics in rural China

BackgroundIn rural China, patients have free choice of health facilities for outpatient services. Comparison studies exploring the attributes of different health facilities can help identify optimal primary care service models. Using a representative sample of Chinese provinces, this study aimed to compare patients’ rating of three primary care service models used by rural residents (public clinics, public hospitals and private clinics) on a range of health care attributes related to responsiveness.MethodsThis was a secondary analysis using the household survey data from World Health Organization (WHO) Study on global AGEing and adult health (SAGE). Using a multistage cluster sampling strategy, eight provinces were selected and finally 3435 overall respondents reporting they had visited public clinics, public hospitals or private clinics during the last year, were included in our analysis. Five items were used to measure patient perceived quality in five domains including prompt attention, communication and autonomy, dignity and confidentiality. ANOVA and Turkey’s post hoc tests were used to conduct comparative analysis of five domains. Separate multivariate linear regression models were estimated to examine the association of primary care service models with each domain after controlling for patient characteristics.ResultsThe distribution of last health facilities visited was: 29.5% public clinics; 31.2% public hospitals and; 39.3% private clinics. Public clinics perform best in all five domains: prompt attention (4.15), dignity (4.17), communication (4.07), autonomy (4.05) and confidentiality (4.02). Public hospitals perform better than private clinics in dignity (4.03 vs 3.94), communication (3.97 vs 3.82), autonomy (3.92 vs 3.74) and confidentiality (3.94 vs 3.73), but equivalently in prompt attention (3.92 vs 3.93). Rural residents who are older, wealthier, and with higher self-rated health status have significantly higher patient perceived quality of care in all domains.ConclusionsRural public clinics, which share many characteristics with the optimal primary care delivery model, should be strongly strengthened to respond to patients’ needs. Better doctor-patient interaction training would improve respect, confidentiality, autonomy and, most importantly, health care quality for rural patients.

Comprehensive understanding of health-seeking behaviour among pulmonary tuberculosis patients in China.

In China, there were 918 000 tuberculosis (TB) cases in 2015 alone. The primary challenge facing TB control is the allocation of limited health care resources. To gain a comprehensive understanding of the first choice of health care facility among Chinese patients with suspected pulmonary TB (PTB) and the number of visits required to make the diagnosis. Relevant full-text articles in three Chinese and one English literature databases up to November 2016 were reviewed. Meta-analyses were performed using Stata v12.0. Among 1257 potentially relevant selected articles, 27 cross-sectional studies involving 9891 patients were included in the final analyses. Most PTB patients chose county-level hospitals (40%, 95%CI 33-46) and village clinics (34%, 95%CI 27-42); only 13% (95%CI 10-16) of patients chose to visit PTB dispensaries first. Before obtaining the correct diagnosis, 28% (95%CI 11-44) of patients had to visit health facilities more than three times. Patients with suspicion of PTB were more likely to visit low-level facilities than dispensaries. Repeated visits resulted in both overall delay and high risk of PTB transmission. These findings suggest that a shift in government policy for PTB is required.

Factors affecting health tourism and international health-care facility choice

PurposeHealth-care tourism has become a major industry in the past decade. Following the increasing activity in health-care tourism, the decision-making process of consumers in choosing an international health-care facility has become increasingly important to the related parties. The present study aims to offer a holistic model of international health-care facility choice that incorporates the important dimensions by assessing the growth drivers and the alternative factors proposed in the literature and by validating them via a survey study.Design/methodology/approachThe factors deemed important in the existing literature were used as the basis of a study in Turkey. In total, 65 structured interviews were conducted with health-care professionals and international health tourists to understand the perspective of the two important parties that affect policymaking.FindingsThe findings of the study support the significance of the majority of the variables proposed as important factors affecting international health-care facility choice.Research limitations/implicationsThe study was carried out in four large hospital chains in Turkey; however, this creates a limitation in scope and may have limited representativeness of the overall market. The model has yet to be tested on a larger scale.Practical implicationsThere are significant differences in the opinions of professionals and international health-care tourists in terms of choice criteria. This indicates problems with health professionals’ understanding of the consumer decision process.Originality/valueThe study provides a model that can be used to gain insights on the consumer decision process and also provides the policymakers and stakeholders of the international health-care industry with a sound theoretical foundation to build further studies upon. Only a limited number of studies was carried out in Turkey that focus on international health-care tourism, and the present study will fill a substantial research gap.

Examining the changing health care seeking behavior in the era of health sector reforms in India: evidences from the National Sample Surveys 2004 & 2014

BackgroundHealth policy formulations in India have witnessed a shift from a reactive approach to a more proactive approach over the last decade. It is therefore important to understand the effectiveness of recent national health policies (such as the National Rural Health Mission and the National Urban Health Mission) in addressing the varied needs of the heterogeneous population of India.MethodsWe use datasets from the National Sample Surveys carried out in 2004 and 2014 to understand the change in the health seeking behavior as a result of these policies. The choice of health care facilities and the associated expenditures are compared through descriptive analyses. A multinomial logistic regression is used to identify the significant parameters which contribute towards the share of health care providers in India. The health status of two economically disparate Indian states (Bihar and Kerala) are also compared through specific metrics of performance.ResultsIt is seen that due to increased availability of facilities in close proximity, both rural and urban residents prefer to avail of those facilities which will result in minimization of transportation cost. The effectiveness of national health policies is found to vary on a regional scale. Literacy and health status have a strong correlation, thereby reinforcing that Bihar still lags far behind Kerala in terms of access to equitable health care.ConclusionTherefore, a hierarchical system, incorporating medical pluralism and tailor-made policies targeted at diverse health care demands, needs to be put in place to achieve Goal 3 of the Sustainable Development Goals as decreed by the United Nations, i.e., “health for all”.

Characteristics of Morbidity and Choice of Health Care Facilities in Nepal

In aftermath of People’s Movement 2008, the Government of Nepal promulgated health as a component of basic human rights. But Nepalese health consumers can seek health care services in government primary health facilities, hospitals, private clinics or do self–medication. The study intends to describe the characteristics of morbidity and factors associated in choosing particular type of health facility. For data, the study depends on a nationally representative rich cross sectional household survey data (Nepal Living Standard Survey, 2010/11) of Nepal. The findings of the study show that around one fifth of the total population reported acute illness while near about 10 percent is facing chronic illness. Around 30 percent of people reporting acute illness do not seek any health care services. Most of the rural people and poor population seek health care services in government primary health care facilities and private pharmacies. People belonging to low income quintiles are likely to seek health care services in government primary facilities. Similarly people residing in mountain & hill are likely to utilize services of government primary facilities. The study shows that urbanites are more likely to seek services in hospitals and private clinics. Therefore a homogeneous health care service production and delivery cannot address the country wide demand of health care services.

Better care provided to patients with tuberculosis at county designated TB hospitals (CTD) compared to non-CTDs in rural China

BackgroundThe primary unit of tuberculosis (TB) medical care in China is the county TB dispensary or county designated hospital (CTD), where patients can receive free diagnosis and treatment. However, a substantial number of patients seek their anti-TB treatment from general health facilities (Non-CTDs). This study aimed to investigate the first anti-TB treatment experience and choice of health facilities of retreated TB patients and their determinants.MethodsA cross-sectional study was conducted in Jiangsu, Shandong and Sichuan provinces. All registered re-treated TB patients were investigated using a structured questionnaire covering information on demographics, socio-economic characteristics, and previous anti-TB treatment experiences.ResultsTotally, 75.3% of 544 patients visited CTD directly for initial treatment. Patients who were female (OR:1.71, 95% CI: 1.01-2.87), over 40 years of age (OR:2.80, 95% CI: 1.24-6.33), from Jiangsu (OR:3.07, 95% CI: 1.57-6.01) and Sichuan (OR:4.47, 95% CI: 2.29-8.73) and those diagnosed before 2005 (OR:6.87, 95% CI: 4.24-11.13) had a significant higher risk receiving their initial treatment at a non-CTD. Patients were more likely to have standardized diagnosis and treatment regimens in CTD (89.8%) than in non-CTDs (65.9%). Patients treated in non-CTDs versus in CTD had a lower possibility to complete their treatment course during first TB episode (χ2 = 3.926, P = 0.048), but there was no significant difference in the cure rate between different facilities (CTD 60.8%, Non-CTDs 59.1%). Patients in non-CTDs incurred higher costs (1,360 CNY) than those treated in CTD (920CNY).ConclusionCTD play a key role in the National Tuberculosis Control Program. Patients should be guided to seek health care in county designated hospital, where they are more likely to receive appropriate examinations, treatment regimens and rigorous supervision, and to bear a lighter economic burden.

A survey of the perception of the quality of and preference of healthcare services amongst residents of Abeokuta South Local Government, Ogun State, Nigeria.

The choice of healthcare facilities by individuals is determined in part by their taste, satisfaction with services, and the perceived quality of care provided. The aim of the study was to explore the healthcare preferences of residents of Abeokuta South Local Government Area (LGA) and their perception of quality of services received, and to determine the factors influencing their choice of healthcare facilities. A descriptive cross-sectional study design was used to assess perception of clients regarding quality of healthcare received and their choice of healthcare service delivery. Data were collected using a pre-tested interviewer-administered questionnaire, and analysis was done using SPSS version 17. Statistical significance was set at P <0.05. The mean age of respondents was 45.7 ± 11.7 years. Government-owned general hospitals were preferred for common health problems such as body pain and fever. Overall, about 73% of the respondents preferred government-owned facilities. Determinants of the preference of the government facilities were reduced cost (P< 0.001) and effectiveness of care (P= 0.024), whereas private facilities were preferred more significantly because of short waiting time and good attitude of staff (P = < 0.001). Almost 78% of the respondents were satisfied with the quality of care received. Government-owned general hospitals were the preferred source of health services and the quality of healthcare services received was generally perceived to be high.

Correlates of Contraceptive Use and Health Facility Choice among Young Women in Malawi.

We explore whether differential access to family planning services and the quality of those services explain variability in uptake of contraception among young women in Malawi. We accomplish this by linking the Malawi Schooling and Adolescent Study, a longitudinal survey of young people, with the Malawi Service Provision Assessment collected in 2013-2014. We also identify factors that determine choice of facility among those who use contraception. We find that the presence and characteristics of nearby facilities with contraception available did not appear to affect use. Rather, characteristics such as facility type and whether contraception was provided free of charge determined where women deciding to use contraception obtained their contraception. We argue that in a context where almost all respondents resided within 10 kilometers of a health facility, improving access to and quality of family planning services may not markedly increase contraceptive use among young women without broader shifts in norms regarding childbearing in the early years of marriage.

Association Between Viewing Health Care Price Information and Choice of Health Care Facility

Association Between Viewing Health Care Price Information and Choice of Health Care Facility

The Individual's Choice of Facility for Maternal Health and Family Planning Services in a Dense Urban Environment: The Case of Senegal

A number of authors have utilized health facility choice models to determine how individuals in developing countries evaluate the tradeoff between the price, quality, and indirect costs of obtaining medical care. A common problem in this literature is that researchers only observe the type of facility that an individual reports visiting (e.g., public or private hospital, health center or dispensary; or traditional healer) and, therefore, must assume patients visit the nearest facility of the type they report. This matching procedure creates measurement error in the choice variable, which may introduce bias in parameter estimates. In this research, we use a data set from urban Senegal that allows for a precise individual-health facility match to estimate consumer preferences for health facility characteristics related to maternal health and family planning services. Using actual rather than imputed choices, we find that consumers prefer high quality health facilities that are nearby. Given the preference for quality, our findings indicate that in contrast to the typical assumption in the literature, individuals frequently bypass the facility nearest their home. When we estimate models using the mismeasured choice variable, the results show a significant bias in preference estimates; most notably, these models systematically overestimate distaste for travel. To highlight a potential consequence of biased preference estimates in this setting, we conclude by simulating the impact of an actual policy that took place in 2014; namely, the opening of a new facility in a previously underserved area of Dakar, Senegal.

THE RELATIONSHIP BETWEEN SYMPTOMS AND HEALTH FACILITY CHOICE IN THE CENTRAL REGION VIETNAM

Background: Patients often have their focus on looking for the high-quality healthcare services while minimizing costs in order to choose the healthcare facilities appropriate to their needs. Moreover, a double burden disease has led to changes in healthcare delivery model and health seeking behavior of patients. However, the relationship between such illness and the utilization of health care services has rarely been empirically assessed. Objective: To clarify how health status and symptoms associated with the healthcare facility choice. Methods: We conducted this survey in 3 provinces (Thua Thien Hue, Quang Tri, and Khanh Hoa), with 6,898 residents in 1,478 households. The International Classification of Primary Care (ICPC-2) was used to classify the symptoms. Results: There were 1,816 people having illness/injury during the last 3 months (26.3) and the majority of them went to CHCs when they got sick. Patients with digestive, neurological and respiratory symptoms were more likely to use CHCs as the first contact point. In contrast, people with musculoskeletal, female genital, and urological diseases were more likely to visit the higher level facilities such as provincial and central hospitals than CHCs. Key words: Healthcare sevices

The Role of Economic Factors in the Choice of Medical Providers in Rwanda

The purpose of this paper is to investigate the role of economic factors in choosing alternative service providers and to recommend suitable measures that could be taken to improve the use of health services in Rwanda. The study uses a multinomial logit framework and employs the Integrated Household Living Conditions Survey (EICV2) conducted in 2005 by the National Institute of Statistics of Rwanda (NISR). To handle the problem of endogeneity, we estimate a structural model. The results indicate that health insurance is an important factor in the choice of health facilities. User fees are major financial barriers to health care access in Rwanda. The results suggest that as household income increases, patients shift from public to private health facilities where quality is assumed to be high. A number of policy recommendations emerge from these findings. First, as insurance is an important factor in choosing a health care facility, policies that reduce health care costs to patients would substantially increase the use of health services. Second, since an increase in income allows the patient to shift to private facilities, the government should consider subsidizing private health facilities to enable access to care in private sector facilities by low-income households. Finally, since distance affects access to health care in Rwanda, there is a need to improve geographical accessibility to health facilities across regions by upgrading and expanding transportation and health infrastructures.

Health Provider Characteristics and Choice of Health Care Facility among Ghanaian Health Seekers

—Although largely controlled by government, Ghana's health delivery system has witnessed dramatic growth in private sector participation. This growth is important for consumers of health care because it provides a wide range of choices, while informing health providers, through consumer feedback, of the quality indicators relevant for improving their services. For consumers of health care, measuring and monitoring quality based on health provider characteristics is crucial to making appropriate choices, especially because these have implications for morbidity, mortality, and longevity. There is limited research in sub-Saharan Africa, and Ghana in particular, that examines how health provider characteristics associate with choice of health facility. Using recently collected data from the Ghana Demographic and Health Survey and employing random intercept models, we fill this research void. Results showed that Ghanaian men and women who were satisfied with wait time at the health facility were significantly more likely to have visited private health facilities compared to public health facilities. Similarly, Ghanaian women who appeared satisfied with conditions at the health facility and accessibility of the health facility were significantly more likely to have visited private hospitals compared to public hospitals. This study provides important evidence to policy makers and major stakeholders in the public health sector of the need for quality adjustments and the relevance of improving health care delivery in the public health facilities.

Healthcare Facility Choice and User Fee Abolition: Regression Discontinuity in a Multinomial Choice Setting

Summary We apply parametric and non-parametric regression discontinuity methodology within a multinomial choice setting to examine the effect of public healthcare user fee abolition on health facility choice by using data from South Africa. The non-parametric model is found to outperform the parametric model both in and out of sample, while also delivering more plausible estimates of the effect of user fee abolition (i.e. the ‘treatment effect’). In the parametric framework, treatment effects were relatively constant—around 10%—and that increase was drawn equally from home care and private care. In contrast, in the non-parametric framework treatment effects were largest for large (and poor) families located further from health facilities—approximately 5%. More plausibly, the positive treatment effect was drawn primarily from home care, suggesting that the policy favoured children living in poorer conditions, as those children received at least some minimum level of professional healthcare after the policy was implemented.

Effect of National Health Insurance Holding on the Choice of Health Facility for Childbirth in Ghana

Maternal and child mortalities are among major health problems facing developing countries such as Ghana. Most of these deaths can be avoided by utilization of maternity health care services. The study examines the effect of health insurance holding and other socioeconomic and demographic factors on the choice of health facility for childbirth in Ghana. The study used data from the 2008 Ghana Demographic and Health survey. Data were analyzed for descriptive statistics as well as a Multinomial Logistic Regression for identification of factors that influence delivery in health facility. The study results have shown that, holding of health insurance and wealth significantly influences expectant mother’s decision to use government health facilities for childbirth. Also, the study revealed considerable variations in region and between rural and urban utilization of this services in Ghana. It is recommended that in order to improve the utilization of health facility for childbirth services and hence maternal health care utilization, there is the need to improve public awareness and efforts should also be taking by policy makers to integrate the private sector properly into the National Health Insurance scheme. Policy should also target mothers who have had the experience of child birth on the need to use health care facility services for each pregnancy. The government and other service providers (NGOs, religious institutions and private providers) may endeavor to improve on the distribution of health facilities, human resources, good roads and necessary infrastructure among other things in order to facilitate easy access to health care providers especially for rural dwellers.

Effects of the health insurance coverage extension on the use of outpatient services among small children in rural China.

A new public health insurance scheme has been gradually introduced in rural provinces in China since 2003. This would likely cause an increment in the use of health services. It is known that the association between health insurance coverage and health service utilization varies among different age groups. This study aims to examine the association between extending health insurance coverage and increment in outpatient service utilization of small children in rural China, and to identify other factors associated with the outpatient service utilization. A household survey was conducted in 2 counties in north China in August 2010, targeting 107 selected households with a child aged 12-59 months. The questionnaire included modules on demographic information such as ages of children and parents, enrollment status of health insurance, the number of episodes of illness as perceived by parents, month of incidence of episode and outpatient service utilization at each episode. Based on the utilization at each episode of illness, a random effects logistic regression model was employed to analyze the association. It was found that eligibility for the reimbursement of outpatient medical expenses was not significantly associated with decision to seek care or choice of health facility. This might be in part due to the low level of reimbursement which could discourage the use of insured, and to the close relationship with village clinic workers which would encourage the use of uninsured. Three other factors were significantly associated with increment in the outpatient service utilization; age of children, mother's education, and number of children in a household.

An Assessment of the National Health Insurance Scheme in the Sekyere South District, Ghana

As part of government’s pro-poor strategy to increase access to and improve the quality of basic healthcare services, the National Health Insurance Act (National Health Insurance Authority, 2003, 2010 and 2013) was passed in 2003. The study assessed 379 heads of household, 5 heads of health facilities and the scheme managements’ perception on quality of health service delivery, implementation of the capitation programme, operation of the National Health Insurance Scheme (NHIS) and performance of scheme operators and service providers in the Sekyere South District of Ghana. Findings indicate that 73.9% of the heads of household had registered for NHIS and out of this figure 74.5% had renewed their cards. Despite a high renewal level, 30.3% are not satisfied with the services provided. With the introduction of the capitation grant, 25% of private service providers have withdrawn their services due to inadequate per capita payment on the scheme and 17.3% of the heads of household had difficulty in tracing their names at their preferred choice of health facility which have the tendency of affecting the sustainability of the NHIS. The study therefore recommends that, the National Health Insurance Authority should ensure upward adjustment of the monthly per capita payment made to service providers to reflect reality and also intensify education on the capitation policy for both service providers and the scheme beneficiaries.

Community-Engaged Public Health Research to Inform Hospital Campus Planning in a Low Socioeconomic Status Urban Neighborhood.

To compare sociodemographic and motivational factors for healthcare use and identify desirable health-promoting resources among groups in a low socioeconomic status (SES) community in Chicago, IL. Disparities in health services and outcomes are well established in low SES urban neighborhoods in the United States and many factors beyond service availability and quality impact community health. Yet there is no clear process for engaging communities in building resources to improve population-level health in such locales. A hospital building project led to a partnership of public health researchers, architects, and planners who conducted community-engaged research. We collected resident data and compared factors for healthcare use and choice and likelihood of engaging new health-promoting services. Neighborhood areas were strongly associated with ethnic groupings, and there were differences between groups in healthcare choice and service needs, such as, proximity to home was more important to Latinos than African Americans in choice of healthcare facility ( p adj = .001). Latinos expressed higher likelihood to use a fitness facility ( p adj = .001). Despite differences in vehicle ownership, >75% of all respondents indicated that nearby public transportation was important in choosing healthcare. Knowledge of community needs and heterogeneity is essential to decision makers of facility and community development plans. Partnerships between public health, urban planning, architecture, and local constituents should be cultivated toward focus on reducing health disparities. Further work to integrate community perspectives through the planning and design process and to evaluate the long-term impact of such efforts is needed.

MEDICAL SERVICE&amp;NBSP;UTILIZATION IN PHU LOC DISTRICT, THUA THIEN HUE PROVINCE

Objectives: 1. To explore the utilization of medical services in Phu Loc District, Thua Thien Hue Province; 2. To examine some related factors to medical services utilization in Phu Loc District, Thua Thien Hue Province. Methods: A cross sectional study using questionnaire interview of 3258 residents in 800 households. Results: There were 352 people got sick during the one month period before interview of whom 95,3% respondents were sick one time and most cases were mild illness (60,5%). Respiratory problems accounted for the largest proportion. Among sick people, 33,8% of them used medical services at Commune Health Center (CHC), 20,2% treated at hospital, 12,8% used private clinic; and self treatment was still high (33,2%). Age group, the perceived serious level of illness, and having health insurance are significantly associated with the medical services utilization. The main reasons for using CHC are having health insurance (83,2%) and that CHC is near their home (75,6%). The major reason for not using CHC is the low quality of medical service at CHC (45,9%). Waiting time, the trust to medical staff, and satisfaction with consultation time are associated with the choice of health facilities. When assessing the quality of primary care of health facilities using the Primary Care Assessment Tools (PCAT), CHC had the highest score in the Comprehensiveness domain and the private clinics achieved the highest score in the Ongoing Care domain.