Determinats of commune health center (CHC) usage in Long An province.pdf
1. NATIONAL UNIVERSITY OF HCM
UNIVERSITY OF ECONOMICS
VIETNAM
INSTITUTE OF SOCIAL STUDIES
THE HAGUE
THE NETHERLANDS
VIETNAM-THE NETHERLANDS
PROJECT FOR M.A ON DEVELOPMENT ECONOMICS
DETERMINANTS
OF COMMUNE HEALTH CENTER (CHC) USAGE
IN LONG AN PROVINCE
A thesis submitted in partial fulfillment ofthe requirements for the degree of
MASTER OF ARTS IN DEVELOPMENT ECONOMICS
BY
HUYNH DANG BICH VY
Academic Supervisor:
DR. NGUYEN VAN PHUC
BQ GIAO DVC VA 8AO -;-; ; .
TRVdNG E>H KINH TE TP.I·ic;·.~
THUVIEN
j; . ( ~c }f-
HO CHI MINH CITY, AUGUST 2007
2. ACKNOWLEDGEMENTS
Firstly, I would like to express my deep gratitude to all professors and
teaching staff in Vietnam-Netherlands programme on Development Economics
for their lectures, instructions and the best teaching conditions during my study
period from 2004 to present.
The author would like to give a special thanks to Dr. Nguyen Van Phuc, the
author's supervisor, for his scientific instructions and his valuable comments on
this study. In addition, the author owes special gratitude to Mr. Truong Dang Thuy
and Mr. Luong Vinh Quoc Duy for their enthusiastic help and criticism.
This research would have been completed difficultly were it not for the
kind and warm welcome of individuals from over 100 households in Can Duoc
and Can Giuoc district during the survey. Thanks are due to many friends that I
could not fully list here for their strong supports ofthe survey and their invaluable
encouragements and nice wishes.
And last but not least, all my love is devoted to my parents and brother who
always help and encourage me during my learning and doing this study.
Again, the author is really grateful to all people for their help. Any errors in this
research are my responsibility alone.
3. CERTIFICATION
I certify that the substance ofthis thesis has not already been submitted for
any degree and is not being current submitted for any other degree.
I certify that to the best of my knowledge any help received in preparing
this thesis, and all sources used, have been acknowledged in this thesis.
HUYNH DANG BICH VY
4. ABSTRACT
Many studies of the utilization of health care system have been done in
different countries over the world. In most developing countries like Vietnam,
people mainly live in rural area; hence rural health care sector plays an important
role. One of health care providers is commune health center that provides basic
health care. Therefore, this study's purpose is to investigate determinants of
commune health center usage; specifically it aims at examining the effects of
individual income.
Binary logit model was used to find out the answers for the questions ofwhat
determinants of using health care services from CHC are and whether with higher
income people tend to use more CHC services or not. The author has applied the
method of multi-staged sampling to collect data in Can Duoc and Can Giuoc
districts, Long An province. The object of this research is individuals aged 15 and
older that are the adult population and have enough civil capacity to make their own
decisions.
The results show that income is a relatively important determinant of CHC
-----cnoice -in.-can Duoc and-Catlviuo-c-districts:-Furthermore;-other-factors-such-as-
socio-demography, severity of illness and characteristics of the CHC provider are
significantly important. These results are useful to give several recommendations to
improve the quality ofCHC services in order to satisfy particular income group.
5. TABLE OF CONTENTS
CHAPTER 1: INTRODUCTION.................................................................................... I
1.1.PROBLEM STATEMENT ................................................................................................ 1
1.2.RESEARCH OBJECTIVES ............................................................................................... 2
1.3 .RESEARCH QUESTIONS ................................................................................................ 2
1.4.METHODOLOGY .......................................................................................................... 2
1.5. HYPOTHESIS .............................................................................................................. 2
1.6.RESEARCH SCOPE........................................................................................................ 3
1.7. THESIS STRUCTURE .................................................................................................... 3
CHAPTER 2: LITERATURE REVIEW .........................................................................5
2.1.DEFINITIONS ............................................................................................................... 5
2.2.THEORY OF CONSUMER BEHAVIOR .............................................................................. 6
2.3 .THEORIES OF FACTORS AFFECTING HEALTH CARE DEMAND .......................................... 7
2.4.MODEL ....................................................................................................................... 9
2.5.SUGGESTED RESEARCH VARIABLES............................................................................ 12
CHAPTER 3: AN OVERVIEW OF HEALTH CARE PROVIDER IN VIETNAM........ 19
3.1.BACKGROUND ON VIETNAMESE HEALTH CARE SYSTEM .............................................. 19
3.1.1.Achievements ....................................................................................................... 19
3.12. Shortcomings ....................................................................................................... 21
3.2.COMMUNE HEALTH CENTER ...................................................................................... 22
CHAPTER 4: RESEARCH METHODOLOGY, ESTIMATION AND RESULS •••••.•••••27
4.l.DATA COLLECTION METHODS .................................................................................... 27
4.1.1.Sampling technique .............................................................................................. 27
4.1.2.Sample size........................................................................................................... 28
4.2.DATA ....................................................................................................................... 29
4.2.1.The main contents ofthe questionnaire ................................................................ 29
4.2.2. Dependent variable ............................................................................................. 30
4.2.3. IndeJJendent variables..........._._._.,..._.~··~·~._.~._. .._................................................. 30
4.2.3.1. Socio-demographic characteristics........~.~-:_::.~-::.-:::.~~:=~~-::_-::::.~-::.~.-::.=.-30- -
4.2.3.2 Individual and household income ........................................................... 32
4.2.3.3 The characteristics ofthe perceived illness............................................. 33
4.2.3.4. Attributes ofhealth care provider and the non-monetary cost................ 35
4.3.STRENGTH AND WEAKNESS OF COLLECTED DATA ....................................................... 41
4.4.REGRESSION RESULTS ............................................................................................... 42
CHAPTER 5: CONCLUSIONS AND RECOMMENDATIONS..................................... 50
5.l.CONCLUSIONS........................................................................................................... 50
5.2.RECOMMENDATIONS ................................................................................................. 51
REFERENCES:...........................................................................................................52
APPENDICES: ............................................................................................................56
APPENDIX 1: .............................................................................................................56
APPENDIX 2: .............................................................................................................60
APPENDIX 3: .............................................................................................................64
6. LIST OF TABLES
TABLE 2.1: The expected signs ofdeterminants ofhealth care usage ................................ 17
TABLE 3.1: Infrastructure in three levels ofpublic health care system in 2006 in
Vietnam ...............................................................................................................................23
TABLE 3.2: The proportion ofout-patient health service contacts ofeach level ofincome
people at each type ofprovide ............................................................................................25
TABLE 4.0: Appropriate sample size ................................................................................29
TABLE 4.1: The number and the percentage ofobservationsfor each type ofproviders.....30
TABLE 4.2: Basic socio-demographic characteristics ofthe respondents ..........................31
TABLE 4.3: Average income of respondent and average income per capita per month ....32
TABLE 4.4: Mean individual income offive groups ..........................................................33
TABLE 4.5 Choice ofprovider by income quintile .............................................................33
TABLE 4.6: Results ofthe survey CHC andnon-CHC respondents in terms oflDAY ........34
TABLE 4.7: Results ofthe survey CHC and non-CHC respondents in terms ofRDAY........35
TABLE 4.8: Availability ofdrugs in the CHC.....................................................................36
TABLE 4.9: Total expenditure for consultation and drugs .................................................37
TABLE 4.10: The number ofobservations that people have used specific health care
provider .............................................................................................................................38
TABLE 4.11: Data definitions ...........................................................................................39
TABLE 4.12: Logit regression results ...............................................................................43
TABLE 4.13: The changes in the probability ofusing CHC provider ifhaving change in
-------------ageCJrlevel-of-education;-given-otherfactors--;-;;-=;-.-;-;-;~-.-.-;-;-;-;;-;,-;o.;;-;-;-;;~-.=••........••-
...,••,-.-.-.-.-.••••••••44--
TABLE 4.14: The changes in the probability ofCHC usage ofmale andfemale if age
increases by one year, given otherfactors ........................................................................45
TABLE 4.15: The changes in the probability ofCHC usage ofmale andfemale ifthe
ratio ofdistance increase by one unit, given otherfactors ..................................................45
TABLE 4.16: The changes in the probability ofCHC usage ofmale andfemale ifthe user
fee ofCHC is cheaper, given otherfactors .........................................................................46
TABLE 4.17: The changes in the probability ofCHC usage ifchanging severity of
illness, given otherfactors................................................................................................... 47
TABLE 4.18: The changes in the probability ofCHC usage as having change in income,
given other factors .............................................................................................................. 48
TABLE 4.19: Descriptive statistics of variables .............................................................,.56
TABLE 4.20: Correlations among independent variables ..................................................58
7. LIST OF FIGURES
FIGURE 2.1: The behavioral model ....................................................................................7
FIGURE 2.2: Choice ofa health care provider ...................................................................8
FIGURE 3.1: Total expenditure on health (THE) as% ofGDP .........................................20
FIGURE 3.2: Total expenditure on health in million VND for 1996-2005 ..........................20
FIGURE 3.3: Inequality in the use ofhealth services .........................................................22
FIGURE 3.4: Proportion ofout-patient health care service visits by type ofprovider.........24
FIGURE 3.5: Main reasons for choosing outpatientfacility used ......................................25
8. CHC
GSO
LHS
MOH
MTEF
RHS
SD
UNDP
UNICEF
VDR
VLSS
VNHS
WB
WHO
ACRONYMS
Commune Health Center
General Statistics Office
Left Hand Side
Ministry ofHealth
Medium-Term Expenditure Framework
Right Hand Side
Standard Deviation
United Nations Development Programme
United Nations Children's Fund
Vietnam Development Report
Vietnam Living Standards Survey
Vietnam National Health Survey
World Bank
World Health Organization
9. CHAPTER I
INTRODUCTION
The introduction chapter consists of six parts. The problem statement is presented
in section 1.1. The following parts such as research objectives, research questions,
methodology, and hypothesis are in section 1.2, 1.3, 1.4, and 1.5, respectively.
Research scope as well as several reasons for choosing Can Duoc and Can Giuoc
districts as research places is revealed in section 1.6. The last section is thesis
structure.
1.1 Problem statement
Health sector is one of main concerns of many countries in the world as
well as in VietNam. During the period since Doi Moi (Renovation) to the present,
the government has invested resources and implemented many reforms in this
sector.
The rural heath care system is strengthened as the government's priority
because around 72.9% of 84,108 million Vietnamese people live in rural area
(UNDP, 2006). It is organized at four levels: national, province, district, and
commune (Tran Tuan, 2004). Together with private providers and self-medication,
almost all communes have a commune health centre (CHC). According to Nanak
Kakwani and Hyun H:-Son-(2U01i)~-CHC seems to play an-impoftantrole_in__ -
providing basic health services to the poor in Viet Nam. In particular, CHC is
responsible for primary curative care service in a community, especially in rural
area. However, the role of the commune health center has declined. One of the
reasons of this is that a large part of primary curative care service is shared with
other providers. Another reason is that people tend to seek higher quality health
care services because ofan improvement of living standard. The CHC system only
retains its dominant role in preventive care (Tran Tuan, 2004). This study
investigates determinants of CHC usage and finds out whether CHC is normal or
inferior goods, especially in two districts of Long An province, namely, Can Duoc
and Can Giuoc. This kind of information would help decision makers develop
1
10. appropriate plan for CHCs. Since, suppliers could provide appropriate health care
services and contribute to conduct an accessible and affordable health service to
consumers. Therefore, this research concentrates on investigating determinants of
commune health center usage in Can Duoc and Can Giuoc districts, Long An
provmce.
1.2 Research objectives
General objective is to examine the factors affecting commune health center
usage in Can Duoc and Can Giuoc districts, Long An province
Specific objectives are to measure the effect of individual income on CHC
usage and to propose appreciate plan for CHCs to satisfy the demand for health
care services ofpeople living in the two research places.
1.3 Research questions
A general question is: what are determinants of using health care services
fromCHC?
And the other is: Are individuals with higher income more likely to use
health care service from CHC?
1.4 Methodology
Descriptive methods are used to review the background conditions of
Vietnamese health care system, especially health care information from survey in
Long An province. Moreover, an econometric model is formulated to examine the
relative effects of various determinants of CHC usage. In particular, the author
applied binary logit model to find out answers for the above research questions.
1.5 Hypothesis
The study hypothesis is that there is a negative relationship between
individual income and CHC usage in rural area. The higher income is, the higher
demand for health care facilities with high quality such as public or private
hospitals, private clinics is. As a result, demand for CHC usage will reduce.
2
11. 1.6 Scope of the research
Data for this research were collected from households in Can Duoc and Can
Giuoc districts, belonging to Long An province, in March 2007. There are 154
observations collected from over 100 households in the author's survey. The
author chose the two districts to be research place due to following reasons:
Firstly, Can Duoc is the author's home town that motivates me to choose it
in order to do this research. Furthermore, with the support of the author's friend
who lives in Can Giuoc district, to familiar with the geography, living conditions
and culture of local people made collection ofdata less difficult.
Secondly, Can Giuoc and Can Duoc districts have the same conditions such
as the number of communes that is 17 for each. In addition, the density in the two
districts is also similar, that is 781 and 787 people per square kilometer,
respectively.
Finally, they are rather near to Ho Chi Minh city that have many modem
health services. Respondents living in there can choose various health care
providers that may lead to reduce in CHC usage. Therefore, to examine
determinants ofCHC usage in Can Giuoc and Can Duoc districts is necessary.
1.7 Thesis Structure
The outline ofthis thesis is organized following:
Cliapter r:Tntroauction.-Tlle problem statement is presented-to---expresstrre----
significant for investigating determinants of CHC usage and finds out the effect of
income on the CHC usage of individuals in Can Duoc and Can Giuoc districts,
Long An province.
Chapter 2: Literature Review. This chapter includes definitions of CHC,
theoretical background in terms ofconsumer behavior, theory and model of factors
affecting health care demand. In addition, results of empirical studies also are
presented in this chapter.
Chapter 3: Overview of Health Care System in Vietnam. This chapter
provides major information on rural health care system such as the gains as well as
3
12. shortcomings. In addition, infrastructure and reasons for choosing each level,
especially the CHC usages are also contained.
Chapter 4: Research Methodology, Estimation and Results. In this chapter,
there will be the sampling technique, sample size, data description as well as the
strengths and the weakness of data collected. Moreover, regression results and
interpretation ofthe study will be presented and analyzed.
Chapter 5: Conclusions and Recommendations. This chapter contains a
summary ofthe findings, and gives some recommendations.
4
13. CHAPTER2
LITERATURE REVIEW
This chapter includes five main parts. Section 2.1 is concepts that are
defined in order to avoid confusing the meanings ofthese concepts. The theory of
consumer behavior will be presented in section 2.2. The next part, section 2.3, is
theories of factors affecting health care demand. Section 2.4 deals with the model
of factors in determining household choice of health care provider. The final part,
section 2.5, is empirical studies that illustrate the results ofvarious studies in order
to support the theoretical background.
2.1 Definitions
Commune health center (CHC)
Definition of CHC is based on the official explanation of the structure of
rural health care system in Vietnam by Hung, Anderson et al, in 2000 (Tran Tuan,
2004). CHC is the first level contact for health care in the public health system.
The CHC is responsible for delivery of primary health care in a community. It
includes preventive care, normal obstetrics, drugs, family planning and overall
health improvement in the community. The CHC is guided by the district health
center for technical matters and is supported by the Chairman of the Commune
People's Committee for health development activities in the commune.
---H-ealth-insurance-------------------- -------------------------- -----
In Vietnam, according to the study of The Ministry of Health and General
Statistics Office (2001~2002), health insurance is a form to carry out the social
welfare policy and considered as a mechanism to gain a just implementation in the
healthcare field through financially supporting people to access medical services,
to be free from any concerns of financial matter when falling ill, especially for low
and average income persons. It is indicated by the Regulations on health insurance
issued in attachment to the Decree No. 58/1998/N§~CP of the Government on
health insurance and the Circular guiding health insurance development that there
are two health insurance forms: obligatory health insurance and voluntary health
insurance. Obligatory health insurance is the form in which the main contribution
5
14. 2% is from the State Budget or the employers while the remaining 1% is from the
individuals or the Government in case ofretirees, social policy persons. Voluntary
health insurance is the form applied for those people not belonging to the first one.
In addition, there are other forms such as Humanity Health Insurance bought by
international organizations for groups of people such as the Red Cross buys the
health insurance cards for particular sick people...
In the context of this study, the term "health insurance" is defined to all
kinds ofhealth insurance.
2.2 Theory of consumer behavior
According to Pindyck and Rubinfeld (2000, p.62), theory of consumer
behavior is the description of how consumers allocate incomes among different
goods and services. Given their preferences and limited incomes, the decision
maker always chooses the alternative for which the expected value ofthe utility is
maximum. In economics, utility is a measure of the relative happiness or
satisfaction gained. In this study, it is assumed that an individual faces budget
constraint and the choice between consuming two kinds of goods as health care
and other goods. The utility function on choosing a specific health care provider is
considered. For maximizing utility, an individual's health care provider choice will
be CHC provider i if expected utility that person receives from CHC provider
~- -~- -~ -~--- ---m--gller-thmrfrom-otherproviders:- -----
Un = max (Uu ) where j f. 1
Where i: typically individual i,
j: type ofhealth care providers.
j = 1means individual choose treatment from CHC provider.
j =0 for other providers.
Estimate the probability ofchoosing CHC provider, we have:
Pr G= 1) = Pr (Uil > UiO)
6
15. 2.3 Theories of factors affecting health care demand
Since the early 1960s, models of health care demand have evolved. Early
health care demand models were simple reduced-form equations that derived from
the assumption ofutility maximization (Mwabu et al., 1993).
Andersens analyzed three groups of determinants of the choice of a health care
provider that were illustrated in his model of families' use ofhealth services. Three
major components are, namely, predisposing, enabling, and need factors that
showed in figure 2.1 (Andersens, 1995).
Figure 2.1: The behavioral model
Predisposing Enabling
characteristics: resource: Need: Use of health
_____. _____. _____.
Demographic, Personal/ Perceived services
Social Structure, Family;
Health Beliefs Community
Source: Andersens (1995)
In 1995, Andersen systematically reviewed the development of the
behavioral model of health service utilization. Predisposing characteristics
-------------m-cludtrrg-demo-graphic;-social-structure-and-health-beliefs-are-the-:first-gwup.-The
model has been criticized that it, using several variables represents for social
structure such as education, occupation, and ethnicity, did not pay enough attention
to social networks, social interactions and culture. However, Andersen (1995)
affirmed that the measurement of these concepts rightly fit into social structure
components. Besides, health beliefs, according to Andersen (1995), are ill people's
attitudes, values, and health or health-services-knowledge. He found that health
beliefs might be not important as they really be in predicting and understanding
use. The second group is enabling factors which include family and community
resources. He said that enabling resources had to be present for use. For example,
health personnel and facilities should be available at place where people live and
7
16. work. Moreover, he agreed that income, health insurance, and travel and waiting
times were some ofthe measures that could be important.
As time passes, many different determinants have been showed from other
researches on medical care demand patterns in developing countries. For example,
Decor and Ruttens (1998), Habtom and Ruys (2003) concentrated on three groups
of determinants of the choice of a health care provider that are showed in the
figure 2.2. The first group, household and individual characteristics, includes age,
sex, education, socio-economic status, income and occupation. The second group
refers to the characteristics of the perceived illness. The third group is the
characteristics ofthe health service: accessibility, quality ofservice, and user fees.
Figure 2.2: Choice ofa health care provider
Population at risk Variables affecting
choice
(Independent variables)
Possible choices
(Dependent variables)
All Those Household & individual r+ Government health care
members
of
households
in the
~ becoming characteristics (age, sex,
sick or education, mcome,
injured occupation, socto-econ
status)
facilities
community -------------cnaracteristics---uf___tlre- -p.-Mtssiun-- health-----care-
perceived illness (Mild, facilities
Moderate or High
severity ofillness)
Characteristics of the --. Private health care
health service
(accessibility: distance,
travel time, transport
cost; quality and cost of
care)
Source: Habtom G. and Ruys P. (2003)
8
facilities
--. Self-treatment
(self-care + traditional
healer)
17. 2.4 Model
According to Linderlow (2004), recent economic analysis of health care
choices have been derived from the human capital and household production
literature. For example, Grossman, in his studies which were done in 1972,
presented a model in which health entered the utility function. Healthcare, time
and other inputs, and factors in a health production function and the demand for
medical care represented the rational response to a health shock. The health stock
makes people reduce consumption of other goods for medical care in order to
improve their health. Grossman said that an increase in income could lead to an
increase in demand for medical care. There were many empirical studies in
developed countries that have been motivated by Grossman's model. However,
according to Linderlow, in developing countries, data limitations have not
permitted examining based on Grossman's framework.
Therefore, in this research, economic model is based on a simpler static
framework (e.g. Bedi et al., 2003). Bedi et al. (2003), using a standard framework
from Gertler, Locay and Sanderson (1987), Mwabu, Ainsworth and Nyamete
(1993), have examined some factors in determining household choice of health
care provider.
Bedi et al. (2003) have based on different assumptions. The first is that
--------typically individual-onlyconsum:es-two-kinds-of-goods-as-health-care-that-can-be -------
defined by the expect health status and other goods within income constraint. The
second assumption is that consumers attempt to maximize their utility by choosing
a product with attributes, in this case, choosing among alternative health care
providers that will provide them with the highest amount ofutility. The third is the
expect health status of individual which depends on the features of person along
with the quality oftreatment received by individual.
Focusing on the individuals with illness, they have used the utility function.
It includes some elements like the personal health status represented by Hij and the
consumption of all other goods denoted by Cij along with Tij as the non-monetary
cost. The utility function on choosing a specific health care provider is given by:
9
18. Uu =u (Hu, Cu, Tu) (2.1)
Where i: typically individual i,
j: type ofhealth care providers.
Due to the third assumption, Bedi et al. (2003) have given the form of the
function ofhealth production:
Hij = H (Xb Zj) (2.2)
Where: Xi and Zj are the attributes of individual 1 and provider j,
respectively.
Moreover, the first assumption leads to the individual or household income
denoted by Yi includes spending on user fees in terms of a visit to health care
provider Pij and consumption ofother goods Cij. Consequently,
Cij =Yi - Pij (2.3)
Substituting (2.3) and (2.2) into (2.1) results in the form of utility function
be:
Uij = U (Xb Zj, Yi - Pu, Tij) (2.4)
Separating the utility function into two parts as systematic part denoted by
vij that depends on components in equation (2.4) and idiosyncratic part
represented by Eij will results to another form of utility function that is defined as:
Uij- Vu =t-Eij --------{2--:SJ
_________________________________
Following the early literature on health care demand in developing
countries such as Akin et al.(1984), Mwabu (1986), the empirical specification is
based on a linear utility and health production function (Linderlow, 2004) as we
have:
(2.6)
For maximizing utility, an individual's health care provider choice will be
CHC provider if expected utility that person receives from CHC provider highest
among other providers:
UiO = U (Xb Zo, Yi - Pio, Tij) max (Uij ) where j f:. o (2.7)
10
19. Estimating the probability of choosing particular health care provider, such
as private government, mission and self-care, Bedi et al. (2003) have used the
multinomial logit model. Although, individuals in rural area, especially in
communes, can choose from among the different options in terms of CHC, private
provider and self-treatment and traditional medical practitioners, the context ofthe
current study is only about CHC and non-CHC. Non-CHC includes self-
medication, and professional care other than CHC as private treatment. Therefore,
the author used the binary logit model
The problem of choice of health care providers will be solved by using the
above form ofutility function for individuals.
(2.6)
The equation (2.6) could be estimated by regressing the following function:
uij =a+ [31Xi + [32 yi + [33Zij + [34Pij + [3s Tij + Eij (2.8)
The utility function describes the relationship between utility and its
determinants. The former becomes a dependent variable, while the latter become
independent variables for the model.
uij = a + [31Xi + [32 yi + [33Zij + [34Pij + [3s Tij + Eij
The left hand side (!-HS)_~-- dependent variables which are__dummY
variables. If respondent chooses CHC provider, dependent variable will be
assigned a score of one; and the score of zero represents non-CHC treatment
including private facility, self-treatment and others.
The right hand side (RHS) is independent variables as follows:
Xi: the attributes ofindividual i
Yi : the individual or household income
Zj : the attributes ofproviderj
Pij : user fees in terms ofa visit to health care provider
Tij: the non-monetary cost
Sij: idiosyncratic part
11
20. In summary, choosing a specific health care provider of individuals is
defined by different factors such as the characteristics of individuals,
characteristics of providers, individual income, and user fee in terms of a visit to
health care provider, and non-monetary cost.
2.5 Suggested research variables
The first group of attributes of individuals - focus on the socio-
demographic factors of individuals that comprise gender, age, marital status, and
education.
Trivedi (2003) based on the health components ofthe 1998 Vietnam Living
Standards Survey (VLSS) in order to emphasize on econometric modeling of
demand for different types of health care in Vietnam, especially, for CHC
provider. The negative relationship between CHC usage and age as well as
education is founded. CHCs are typically not used by better educated people.
Moreover, Vietnamese older individuals seem to avoid using CHCs. Similar result
was also indicated by Damen in Ethiopia in 2003 (Habtom, Ruys, 2003). He
concluded that when individuals became older, they were more likely to visit
distant and higher quality ofhealth care facilities than local health stations.
Effects of socio-demographic factors on choices of a health care provider
were founded in many studies. However, not all results are the same. Whether the
- ---------effecrofgenaer, being a m-ale, -on-using-h~alth-care-provideris-negative-orpositive- -
depends on a particular provider the researcher considers. For example, in rural
Cote d'Ivoire, male effect is positive and significant in the case of doctor visits
while being negative and insignificant in the nurse choice (Dor and Van der Gaag,
1987). It shows that males are more likely to obtain higher quality heath care.
While in Kenya, women were more likely to be treated by all types of health care
provider than self-medication (Mwabu et al., 1993). Therefore, there does not
appear to be any strong link between gender and the type ofhealth care that people
choose.
Besides, other personal factors like religion and ethnicity may effect on
individuals' decisions among treatments.
12
21. The second group - Attributes of health care provider (Zj) includes
various variables.
Drug availability
There were many indicators of service quality, including the availability of
drugs, the qualification of health care staff, and the availability of equipment
(Mwabu, 1993). Because of data limitation of service quality, many researches
used data of the availability of drugs in order to examine the health care demand
model. Betdi et el. (2003) who used information on about 10,000 households and
over 50,000 individuals from almost all districts in Kenya in 1994 showed clearly
the effect ofdrug unavailability in government facilities on use ofhealth facilities.
They concluded that an increase in the unavailability of drugs sharply reduced the
use ofpublic facilities, leading to an increase in self-treatment.
According to Okello et al. (1998), the hospitals are chosen by people living
both urban and rural area in Uganda rather than the nearest health care because of
unavailability of drugs in the local health center. Another reason for this is to look
for higher level ofhealth quality.
In this research, the author will analyze the effect of availability of drugs on
health care usage and expect that it is positive effect
User fee
--------user fee-is- an ifupoftanCfactor of moaelof-ltealth-car~clrotc-e-;-Several-
studies have analyzed the impact of increases in prices on the use of health care.
This negative relationship was proved in Eritrea by Habtom, Ruys (2003), and in
Kenya by Bedi et al. (2003). In Zaire, for instance, a rapid increase in user fees for
health care resulted in a sharp fall in the demand for curative services. A similar
drop in usage was observed in Mozambique (Dercon, Ruttens, 1998). Moreover,
Bedi et al. (2003) also showed that the increase in user fees in public health
facilities might be matched by an increase in the use of private and mission
facilities. As a result, an expected effect ofuser fees is negative.
13
22. Distance
The other characteristic of health services is distance, that is, the length
from the person's houses to the particular health care facility. In rural areas,
especially, distance and poor quality of services at commune health center have
been cited as possible reasons for continued growth of using self-treatment. It is
said that distance played an important role in choosing health care providers
(Acton, 1975). This variable is expected to affect negatively on CHC usage.
The non-monetary cost - waiting time
It is well known that even in absence of user fees, access to the health
services is not equal due to non-monetary factors such as travel time (Acton,
1975). Therefore, non-monetary factors are very important for health care usage
model. Economic theory indicates that the more time is spent on a health unit, the
lower the probability of patients choosing that provider. Hobtom and Ruys (2003)
considered total time spent on a health unit made of waiting time, treatment time,
laboratory examination time, and time spent at the pharmacy as non-monetary
factors. In Eritea, travel time has a negative effect on the choice of a health care
service provider for most rural residents although it has a positive sign for public
health facilities, especially for hospital.
In this research, the waiting time variable is a proxy for the non-monetary
cosr.-CHC-isalsoa-type of-h--e-alth-care-provider;-if-waiting-time-for-using-€HG -
increases, it is expected that there could be negative effects on usage ofCHC.
The third group includes characteristics of the perceived illness,
insurance and income variable.
Characteristics of the perceived illness is an important factor because it is
described as perceived level of sickness which is expressed as need factor by
Anderson (Habtom and Ruys, 2003). Several studies of Deolalikar and Berhman
(1989), Gertler and van der Gaag (1990) concluded that ill people, especially the
poor, did not go to the facility until when their illnesses were already very serious
(Dercon S. and Ruttens C., 1998).
14
23. Two variables as the number of days of illness and number of days of
limited activity were used to measure perceived severity of illness (Trivedi, 2003).
The results ofTrivedi's research are that the number ofdays ofillness has negative
effect while the number of days of limited activity has positive effect on choosing
CHC usage in Vietnam. On the contrary, the study ofAlbar et al. (1996) found that
in rural areas of Niger, most serious injury cases, either life threatening or long-
term disability creating, were treated by traditional medical practitioners (Habtom
and Ruys, 2003)
In conclusion, whether severity of illness has negative or positive
coefficient on CHC usage must be considered.
Health insurance variable
Similar to other determinants, health insurance also affects on health care
choices. Chang and Trivedi (2003) with the study about self-medication in
Vietnam gave strong suggestion that health insurance diverted demand away from
self-medication and toward higher quality healthcare, for example, government
hospitals. In terms ofusing CHC provider in Vietnam, according to Trivedi (2003)
the relationship between health insurance status and this facility is positive but
with a low level ofprecision. Trivedi (2003) explained that CHCs is considered as
drugs providers ofinsured people.
-------- -------lnilividmiis-and-buusehold-income----------- -
It could be uncertain that whether the effect of the respondent and
household income on the choice of health care treatment is positive or negative.
The sign of income coefficients may be positive if the particular health care
provider is considered by respondents as normal goods. Conversely, the income
coefficient would be negative ifpeople perceived it to be inferior goods.
Trivedi (2003) concluded that Vietnamese CHC is treated by users as an
inferior good. The marginal impact of rising household income on both the
probability and level of usage is negative and significant. However, Chang and
Trivedi (2003) used data from World Bank's Living Standards measurement
survey of Vietnam, 1997-1998 in order to investigate the role ofincome on the use
15
24. of health care facilities. It is concluded that at all income levels, pharmacy is the
most frequently contacted care provider for the sick.
Change in income affects considerably on usage of non-government health
facilities in Kenya. In particularly, an increase in household income would lead to
a rise in health care demand in mission and private clinics (Mwabu et al., 1993).
Income also has a considerable impact on the choice of health care service
provider in Eritrea. Habtom and Ruys (2003) pointed that a one-unit change in
income had increased significantly the probability of selection modern health care
service providers and decreased significantly the probability of self-treatment.
These researchers divided household income into five groups. The results of their
study show that the probability ofselection ofprivate health care provider increase
tremendously as the household income increases by one-unit from middle to the
fourth and from the fourth to the highest group.
However, there are other conclusions that income was a relatively
unimportant determinant of health care choices, particularly in Mozambique
(Lindelow, 2005). Research done by Akin et el. (1986) in the Philippines also
showed that, contrary to prediction of the theory of consumer behavior, economic
variable like household income had little or no impact on health care use.
Therefore, effect of income on health care choices, especially on CHC
usage is amoiguous. --- --- -- --- --------
The expected signs ofvariables are presented in table 2.1.
16
25. Table 2.1: The expected signs ofdeterminants ofhealth care usage
EXPECTED
DETERMINANT
SIGN
Gender Ambiguous
Socio-demographic Marital status Ambiguous
factors Age -
Education -
Health insurance
Insurance +
status
The number ofdays ofillness -
Characteristics of the
perceived illness The number of days of limited
-
activity
Individual and
household income
Ambiguous
Attributes of health
care provider
Drug availability +
Distance -
User fee -
The non-monetary
Waiting time -
cost
In summary, this chapter presents literature review of health care
determinants. The utility function in theory of consumer behavior is considered to
be the main measurement of consumer's satisfaction. Function form of
17 B¢ GIAO D!)C VA 8.~0 T~.O ,
TRUClNG f:H KINH TE TP.HCM
THUVI:¢N
r;;(A~~cY
26. determinants of health care choosing including attributes ofrespondents, of health
care providers, of the perceived illness, the non-monetary cost as well as income
and insurance factor are supported through economic model. The next chapter will
provide an overview of health care system in Vietnam before analyzing details
effects on CHC usage in chapter four.
18
27. CHAPTER3
AN OVERVIEW OF HEALTH CARE PROVIDER IN RURAL AREA
This chapter provides a general picture ofVietnamese health care system. It
contains the figure of total spending on health of people, achievements and
shortcomings in health system presented in section 3.1. It then focuses on major
information on using rural health care system, especially the CHC provider usage
in section 3.2. The main information in this chapter based on the data of VNHS
2001-2002.
3.1 Background on Vietnamese health care system
3.1.1 Achievements
In order to improve the quality and efficiency of health care to respond to
the health needs and to raise health status of the population, under Doi Moi, the
Vietnamese health care system together with the economy has been reformed since
1986 (Tran Tuan, 2004).
According to the national bureau of Asian research in 2006,
administratively, health care system in Vietnam are organized into four levels
including central, provincial, district and commune. The central level is managed
by the Ministry ofHealth; the provincial by the Provincial Health Bureaus; district
---- ----oy Health---uepartmentofllie-oistriccPeople'sCommitte~d--oommune-Ievel-by- -
Health Station ofthe Commune People's Committee.
In terms of function, the system can be divided into various kinds of
services providers such as preventive services, curative services or rehabilitation
care services. In terms of structure, the health system, at the present is a mixed
public-private provider system, in which the public system still plays a key role in
health care, especially in prevention, research and training. The private sector has
grown steadily since the 'reform' of the health sector, but is mainly active in
outpatient care; inpatient care is provided essentially through the public sector.
Figure 3.1 and 3.2 show total expenditure on health as percentage ofGDP
and in million VND, respectively. Accordingly, total health spending remained
19
28. low, at about 5.3 percent of GDP over the last five year period. This is similar to
the average level of health expenditure in the group of low-income countries
(Gerdtham and Ekman, 2005). However, the absolute value increases significantly
during the period time between 1996 and 2005. Total health spending in 2005 is
double compared to 2000's ones while it is triple as high as in 1996.
Figure 3.1
Total expenditure on health (THE) as % of GDP
5.6
5.4
5.2
% 5
4.8
4.6
4.4
4.2
4
96 97 98 99 2000 2001 2002 2003 2004 2005
Year
Source: WHO (2007)
Figure 3.2
Total expenditure on health for 1996-2005
96 97 98 99 2000 2001 2002 2003 2004 2005
Year
Source: WHO (2007)
The government has issued many policies for health care development. For
example, the Health Care Funds for the Poor was established, through Decision
1391
• This decision was an important step toward making health care accessible to
1
Prime minister's Decision 139/2002/QD-TTg.2002. Health Care for the Poor.15 October
20
29. and affordable for the poorest population. Revisions to Decision 139 are expected
to introduce a partial subsidy mechanism to help the near-poor participate in the
voluntary health insurance program.
Furthermore, the Health Master Plan envisions an mcrease in overall
government expenditure on health of the budget will increase from 5.3 percent at
present to 8 percent by 2010. The medium-term expenditure framework (MTEF)
estimates that the cost for the health sector will grow from roughly US dollars150
million USD per year in 2006 to nearly 250 million USD by 2008. The cost
consists of subsidy to the participation of target groups in the health insurance
program, support fully to the poor, ethnic minorities and children under six years
of age, and partially in the case of the near-poor (VDR, 2007). Recently, children
under six years ofage were provided with free access to health care.
Over 84 million of Vietnamese people in 2006, increasing by 1.21% as
compared with 2005 population, are mainly rural farmers which accounted for
about 72.9% percent (GSO, 2006). Primary health care which is the first level of
services accessible to the people is very important in health care system. One of
Vietnam's greatest achievements over the last 30 years is the establishment of
extensive network of commune health centers throughout the country that contains
64 provinces, 659 districts and 10732 communes/wards. In most communes, there
---- ----is a commune liealtli-center (Nguyen Ngocetat}:-- --------------------
3.1.2 Shortcomings
Although gaining impressive results in primary health care and having
many efforts to conduct an accessible and affordable health service to consumers,
there are still many weaknesses, as follows:
The ratio of private health facilities participating in primary health care
activities is very small and the hospital and clinics are often overloaded (WHO,
2005).
Disparities in health indicators point to the large number ofVietnamese not
receiving adequate health care. In addition, there are the sharp differences in health
indicators among areas and among income-groups. In spite of the subsidy and the
21
30. exemption policies issued by the government, health care costs remain
unaffordable for every body. The figure 3.3 points that the poor spend less on
health than the rich, relative to their total expenditure.
Figure 3.3: Inequality in the use ofhealth services
%
7
6
5
4
3
2
1
0
Cost (percent of expenditure)
Poorest Near Middle Near Richest
poorest richest
Hospital contacts (per year)
0.8
0.6
0.4
0.2
0
Poorest Near Middle Near Richest
poorest richest
Source: VDR 2007 (page 97) (based on data from the VLSS 2004)
3.2 Commune health center
Table 3.1 indicates infrastructure in three levels ofpublic health care system
in 2006. This table shows that CHC was responsible for delivery ofprimary health
care in a community. Moreover, the main functions of CHC are preventive care,
normal obstetrics, drugs provider, family planning and overall health improvement
in the community. The heaas-oi commune liealtli-centerswno mostly are luc11lm
people are selected by the Commune People's Committee and the district health
center director. The head of CHC may be a doctor, or an assistant doctor, or other
staff such as a nurse. The total hours that all of the staff must work per day are
eight hours as civil servants.
22
31. Table 3.1: Infrastructure in three levels ofpublic health care system in 2006
in Vietnam
Level Infrastructure
Provincial • 304 general and specialist provincial hospitals located throughout
District
Commune
the 64 provinces, each often has 50-100 beds as well as
consultation and treatment rooms and are staffed by doctors,
nurses, and administrators.
• 64 preventative medicine centers.
• 61 medical secondary schools
• 61 pharmaceutical companies
• 3014 medical specialist groups, 1507 hospital and polyclinics
(more than 600 hospitals)
Each district hospital has about 100 beds, focusing on obstetrics,
geriatrics, and pediatrics.
• more than 10,600 commune health centers, each has from four to
six beds, a delivery room, and a full medicine cabinet
• health stations are staffed by doctors, pharmacists, and nurses
who transport serious cases to district and central hospitals
- - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ~--- ~~---
• health workers who are volunteers involved largely in
immunization and family planning
Source: The national bureau ofAsian research, 2006.
While the only source offunding for the private sector come from user fees,
the CHC also has other sources such as government funds and international
development assistance and local government funds. According to the national
bureau ofAsian research, at the end of2006 a total ofonly 34,702,000 people had
health insurance coverage (41% of Vietnam's population). Although health
insurance has been an important source offunds, it is not a fund for CHC.
23
32. Figure 3.4: Proportion of out-patient health service visits by type of
provider
5.97% 32.01%
7.85%
Source: Vietnam National Health Survey 2001-2002
II] CHC
• District Hospital
~rovincial/Central
Hospital
8:1Private Practitioner
• Other
Figure 3.4 shows the proportion of out-patient health service visits by type
ofprovider. It indicated that the proportion of outpatient health service contacts at
the higher level such as provincial or central hospitals was still low, just at the
level of 7.85%. However, it is not sufficient to conclude whether health services
are inefficient or not. Besides, the number of people seeking CHC is 32.01%,
~ ~ -~-~~-----mainly-by-the-poor,the-near-poor-and-the-average_people. _______________~---~------------
Table 3.2 indicates clearly the relationship between living standards and
outpatient health service contacts. The higher income is, the less CHC usage is.
Living standards increase, the proportion visiting the CHC decreases from 51.83%
to 16.78% and vice versa, use of private practitioners increases from 32.16% by
the poorest to 52.01% by rich people.
24
33. Table 3.2: The proportion of out-patient health service contacts of each
level ofincome people at each type ofprovider
CHC/ District Provincial/ Private Other
Living standard quintile polyclinic hospital Central health facility
hospital service
Poor 51.8 7.9 3.7 32.2 4.5
Near poor 38.9 8.2 4.2 44.2 4.6
Average 33.8 10.1 6 45.4 4.7
Better-off 28 8.6 8.2 48.6 6.6
Rich 16.8 7.8 14.8 52 8.6
Source: Vietnam National Health Survey 2001-2002
Figure 3.5 Main reasons for choosing outpatient facility used
Commune level Higher level public Private
- - - -
oOther resson 32.6 31.8 34.0
•ReQistered health 4.0 19.1 0.2
insuranc3 at this f:~cility
•Only heath care facility in 23.6 1.6 0.2
locality
•Convenient/ nearty 28.6 11.8 27.0
• Trust in cuality 1' .2 35.7 30.6
Source: Vietnam National Health Survey 2001-02
The main reasons why individuals selected health facilities for outpatient
care while alternative facilities were not chosen are shown in Figure 3.5. For
commune level facilities, convenience/nearby or only one facility in the area are
the main reasons. In terms of higher level providers, the main reasons were that
people trust in better quality or health insurance registered at these higher level
25
34. ones. For private health facilities, the main reasons were trust in quality and
convemence.
In short, in this chapter, Vietnamese health care system is summarized,
including central, provincial, district and commune level. One of successes of
government is establishment ofnetwork ofcommune health centers throughout the
country that satisfy the demand for health care of low income people. In addition,
preventive care, normal obstetrics, drugs provider, family planning and overall
health improvement in the community are the main functions of CHC. The main
reasons people use commune level facilities are convenience/nearby or only one
facility in the area In the next chapter, the author will present more clearly
determinants ofCHC usage.
26
35. CHAPTER4
RESEARCH METHODOLOGY, ESTIMATION AND RESULTS
In order to analyze the determinants of CHC usage, binary logit model will
be applied. Section 4.1 describes data collection methods. Section 4.2 presents
contents of data. Section 4.3 is about strength and weakness of collected data.
Section 4.4 provides regression results.
4.1 Data collection methods
4.1.1 Sampling technique
In order to apply the model, data was collected from a random sample of
individuals living in rural areas and confronting with illness. Information was
collected from individuals who had illness in the most recent.
The method of collecting information is multi-staged sampling design. In
Long An province, the author chose two districts such as Can Duoc and Can
Giuoc. In these chosen districts, several communes were randomly chosen,
including Long Hoa, Long Son, Tan Trach, Phuoc Lam, Tan Kim, My Le. In a
specific commune, individuals in households were interviewed to gather
information. In this research, the number of observations is the number of using
--- -----lieallli care services of--a--p-articularprovider-for-the-last-illness-a-re-sponde-nt-had. ---- -
The survey was divided into two stages: pilot and main survey. The
questionnaires were pre-tested before the main survey. A total of30 households in
Can Duoc district were randomly selected in the pilot survey. The purpose of the
pilot survey was to see whether all questions were logical and understood
correctly.
Total number of observations that belongs to 130 households is 180. The
average household size is 4.56 people. However, the author just use information of
154 individuals aged 15 and older who are the adult population and have enough
civil capacity to make their own decisions because the purpose of this research is
investigating the relationship between income and CHC usage (Mwabu et al.,
27
36. 1993). Another reason is that children's demand for health care is different from
adults (Mwabu et al. 1993, Dor aet al. 1987). It is said that children who were sick
tended to deteriorate more rapidly than adults did.
4.1.2 Sample size
The method of calculating the sample stze needed for the survey ts
illustrated as follows:
A pilot survey of 40 observations in two districts was collected in order to
estimate the standard deviation and the mean of the dependent variable involving
two quality choices.
used:
The formula of sample size for a proportion in Godman (1985, p.314) is
Where:
n=
n: sample size
n: sample proportion
Z1: Standard normal value corresponding to the desired level
ofconfidence (y).
A: is the required accuracy.
The value 1t is unknown, and lies between zero and 1. Moreover, the largest
value for n(1 - n) is 0.25, which occurs when 1t = 0.5. If the value 1t by 0.5 is
replaced in the above equation, the value for n(l - n) will be as high as it can be
and the sample size will then be as large as it needs to be.
In this research, the author would select a sample large enough to be at 95%
confident, so Z value is 1.96. Similarly, with level of confidence of 0.9, Z value is
1.65. Moreover, the required accuracy (A) is 0.1.
Therefore, the sample size needed is presented in the below table 4.0
28
37. Table 4.0: Appropriate sample size
Level ofconfidence 0.9 0.95
Sample size (n) 68 96.04
Source: Author's calculations
The number of observations in this research is 154 that are larger than the
required sample size.
4.2 Data
4.2.1 The main contents ofthe questionnaire
The author gathered socio-demographic factors of ill individuals including
gender, years of school as a proxy of education, age, and marital status, religion
and ethnicity. The questionnaire was established in order to seek information on
not only the income of the respondent but also of all members living in the same
household.
Usage data was collected for four types of health care providers such as
commune health center (CHC), private health facility, pharmacy visits (or self-
medication) and others including hospitals as well as traditional Eastern medical
practitioners. The survey certainly included information on the characteristics of
the perceived illness such as the number of days of illness and number of days of
limited activity, the total cost of illness treating including the cost of medical
examinations and the meaicineper-aay--;-tlre-total-miimtes-of-waiting;-taking-- --
medical advices or buying medicine, and the distance from the respondents'
houses to the chosen health care provider, to the nearest health care provider and to
the commune health center.
Whether the individual had health insurance is also asked. Information
about health insurance status ofindividuals is measured as a dummy variable. This
study also examines the effect of enrollment and unenrollment in health insurance
on health care providers of respondents. If respondent enrolls in health insurance,
he/she will be assigned a score of one; otherwise, he/she will be assigned a score
ofzero.
29
38. 4.2.2 Dependent variable
Table 4.1 illustrates the number and the percentage of observations for each
type of providers. The number of cases choosing commune health center is 51,
making up the highest rate of 33.11% of the total observations. Similarly, the
figures of observations choosing private health facility, self-medication and others
are 14.93%, 25.97%, and 25.97%, respectively.
In this research, dependent variable is dummy variable. If respondent
chooses CHC provider, dependent variable will be assigned a score ofone; and the
score of zero represents non-CHC treatment, including others, whose the total
percentage is 66.2%.
Table 4.1: The number and the percentage of observations for each type of
providers
CHC Non-CHC (y = 0)
(y = 1) PRIVATE
FACILITY
Frequency 51 23
Percent 33.11 14.93
Source: Author's calculations.
4.2.3 Independent variables
- - - - - - - - - - - - -
HEALTH PHARMACY
VISITS
40
25.97
4.2.3.1 Socio-demographic charactenstics -----------
OTHERS
40
25.97
Table 4.2 shows the basic socio-demographic characteristics of the
respondents including gender, years of school as a proxy of education, age, and
marital status, religion and ethnicity. Accordingly, in total 154 observations,
female is 65%, about double as many as the figure of male. In terms of age, the
major of respondents who were interviewed are from 31 to 55 years old with a
figure of 57%. The number ofmarried individuals is over twice than the number of
single people. In addition, in Can Duoc and Can Giuoc district, a large part of
people are the Kinh while the number ofethnic people is minor. There is only one
person who is Chinese in 154 interviewed people. Therefore, the variable ethnicity
will be excluded from the specific model.
30
40. 4.2.3.2 Individual and household income
Getting information regarding individual and household income is also the
other difficult part of this research. The author based on the methods used in the
Vietnam Living Standard Surveys (VLSS) to make the questionnaires in order to
collect data on income. The components were individual wage income from
employment, household agricultural incomes, non-farm self-employment income,
rental income and net remittance and other minor sources during a year. After that,
not only the average income per month of specific respondents but also the
average income percapita ofhousehold is estimated.
Table 4.3: Average income of respondent and average income per capita
per month
Unit: VND/month Non-CHC CHC Both
(n=103) (n=51) (n=154)
Average individual income 686391.6 711686.3 694768.4
Average income per capita 608592.1 682811.3 633171.2
Source: Author's calculations
Table 4.3 shows mean values of income for CHC user and non-CHC user.
There is slight difference between mean income of CHC user and of non-CHC
user. Furthermore, average individual income and per income is rather similar.
---- ---------------:-c-----=- -=--~-
In this research, in order to examine the effects otincome on aecisiori-of -
health care provider, the author applies the method ofmeasuring the inequality of a
distribution of income (TBTC 34). Total number of households is split into five
groups, and the number of observations is the same. The first group includes
people having the lowest income; the second is less than average, the third is
average, the fourth is more than average and the fifth one is the highest income
group. The mean income and the number of choices of provider by each income
quintile are presented in table 4.4 and table 4.5, respectively.
32
41. Table 4.4: Mean individual income of:five groups.
Variable Mean Std. Dev. Min Max
INC1 59419.35 62833.52 0 150000
INC2 251546 66060.38 152500 366666.7
INC3 531527.8 101670.9 370000 700000
INC4 961127.5 158652.5 710000 1200000
INC5 1641111 306091.8 1250000 2250000
Source: Author's calculations
Table 4.5: Choice ofprovider by income quintile
Variables Non-CHC CHC Both
(n=103) (n=51) (n=154)
INC1 19 12 31
INC2 19 10 29
INC3 22 8 30
INC4 25 9 34
INC5 18 12 30
Source: Author's calculations
4.2.3.3 The characteristics ofthe perceived illness
The number of days of illness and of limited activity
Following Trivedi (2003), the author defined the concepts ofcharacteristics
ofthe perceived illness. The number of days of illness (IDAY) is the total days an
individual confronts with illness but the severity of sickness do not effect on
respondent's job, activities. The higher severity of illness indicated in the variable
''the number ofdays of limited activity" (RDAY) makes people spend time on sick
leave or spend bed-bound.
33
42. Table 4.6: Results of the survey chc and non-CHC respondents in terms of
IDAY
Valid Cumulative
Frequency Percent Percent Percent
Valid 1.00 17 11.0 11.0 11.0
2.00 24 15.6 15.6 26.6
3.00 45 29.2 29.2 55.8
4.00 11 7.1 7.1 63.0
5.00 9 5.8 5.8 68.8
6.00 2 1.3 1.3 70.1
7.00 16 10.4 10.4 80.5
10.00 12 7.8 7.8 88.3
12.00 2 1.3 1.3 89.6
14.00 2 1.3 1.3 90.9
15.00 6 3.9 3.9 94.8
16.00 1 .6 .6 95.5
20.00 1 .6 .6 96.1
30.00 4 2.6 2.6 98.7
- --- -------50.00-- - -L - - ------ - ---- ___.6___ - - - - - -
.6 99.4
-------------- ------ - --------- ----------
60.00 1 .6 .6 100.0
Total 154 100.0 100.0
Source: Author's calculations
Table 4.6 and 4.7 reveal the results of the survey CHC and non-CHC
respondents with regard to IDAY and RDAY, respectively. According to table 4.6,
the number of days that approximately 88% of individuals confront with illness is
between 1 and 10 days. The rest percentage belongs to 18 people who have from at
least 12 days to 60 days. Moreover, table 4.7 illustrates that over 73% people
whose job, activities are not affected and that the number of heavily ill days
34
43. (RDAY) that about 19% respondents must be absent from work or study are from
1 to 3 while the average ofthis variable is just 1.32 days (in table 4.18).
Table 4.7: Results of the survey chc and non-CHC respondents in terms
ofRDAY
Valid Cumulative
Frequency Percent Percent Percent
Valid .00 113 73.4 73.4 73.4
1.00 10 6.5 6.5 79.9
2.00 11 7.1 7.1 87.0
3.00 8 5.2 5.2 92.2
4.00 1 .6 .6 92.9
5.00 3 1.9 1.9 94.8
7.00 3 1.9 1.9 96.8
10.00 1 .6 .6 97.4
14.00 2 1.3 1.3 98.7
30.00 1 .6 .6 99.4
40.00 1 .6 .6 100.0
Total 154 100.0 100.0
Source: Author's calculations
4.2.3.4 Attributes of health care provider and the non-monetary cost
Information about the attributes of health care provider includes drug
availability, the distance from the respondents' houses to the chosen health care
provider, to the nearest health care provider and to the commune health center,
total expenditure for consultation and drugs for specific treatment as well as the
individuals' thoughts of comparison between CHC cost and the others. Besides,
people were interviewed about the total minutes of queuing, waiting for taking
consultation and buying drugs that represents the non-monetary cost.
In order to estimate the model, data is needed on those variables individuals
faced at different providers. Naturally, the author only observed them to the chosen
provider. How to solve this problem is represented as follows:
35
Tải bản FULL (84 trang): https://bit.ly/3PRzYfi
Dự phòng: fb.com/TaiHo123doc.net
44. Drug availability
Bedi et al. (2003) said that quality ofservices might be expected to lead to a
sharp reduction in the use of public facilities. In this study, the quality of
healthcare services represents the respondent's thoughts about the drug availability
ofCHC provider. This variable "drug availability" is defined as dummy ones. Ifan
individual thinks that CHC provider is available to supply drugs, the score of one
will denote this variable. Otherwise, in a respondent's opinion, if CHC provider is
not available of drugs or people do not know any thing about this information, the
variable "drug availability" will be denoted the score ofzero.
Basing on the data collected, the author estimates in table 4.8 that shows the
people's opinions about the availability ofdrugs in the CHC.
Table 4.8: Availability ofdrugs in the CHC
Non-CHC CHC Both
(n= 103) (%) (n= 51) (%) n= 154 (%)
Drug availability
(DRUG)
Available 66 64 39 76 105 68
Not available 37 36 12 24 49 32
Source: Author's calculations
Accordingly, 76% people--who cliose-CHCto-treaCtheirtllness--saidthat
health care center had enough medicines while 64% ill individuals who selected
the other health care providers for their cures thought similarly.
The distance
Information about the distance illustrated in table 4.18 (in appendix) was
collected basing on two cases:
Case 1: if respondent chose commune health center, the distance from their
houses to the nearest health care provider and to CHC would be asked. DIST is the
ratio between the gap from respondent's house to CHC and the gap from his or her
house to the nearest health care provider.
36
Tải bản FULL (84 trang): https://bit.ly/3PRzYfi
Dự phòng: fb.com/TaiHo123doc.net
45. Case 2: if they chose the others, for example the private facility, the
interviewers would collect the information about the distance from their houses to
not only the chosen facility (e.g. private facility) but also CHC. DIST is the ratio
between the distance from respondent's house to CHC and the gap from his or her
house to chosen facility.
According to the data, the average gap between respondents' house and
CHC is 1456.688 meters. The mean ofthe ratio (DIST) is about 4.6 (see table 4.18
in appendix).
Total expenditure for consultation and drugs
The questionnaire was established to take data on expenditure for
consultation as well as medicines of particular health care treatment. Moreover,
people were also asked their opinions about whether the prices of separate costs
such as consultation and drugs in CHC are cheaper than others or not. In this
research, the author uses dummy variables oftwo kinds of cost. Specifically, ifthe
respondent's answer is cheaper, these variables will be assigned a score of one;
and the score ofzero represents the others.
Table 4.9: Total expenditure for consultation and drugs
Non-CHC CHC Both
(n= 103) (%) (n= 51) (%) n= 154 (%)
User fee
- - - ----- --- ------- - - - - - --- ----- ---------
RCONS
CHC cheaper 44 0.43 42 0.82 86 0.56
Not cheaper 59 0.57 9 0.18 68 0.44
RPRICE
CHC cheaper 43 0.42 43 0.84 86 0.56
Not cheaper 60 0.58 8 0.16 68 0.44
Source: Author's calculations
Table 4.9 shows the results ofthe survey ofthe expenditure for consultation
and drugs. Accordingly, over 80% people who chose CHC to treat their illness said
that prices of not only consultation (RCONS) but also drugs (RPRICE) in CHC
37
6673642
