Public health services use in a mountainous area,Vietnam: implications for health policy

Abstract

Aims : The aim of this study is to describe the use of public health services in different social and ethnic groups and to explore the implementation of user fee exemption in a mountainous area in Vietnam. Methods: A cross-sectional household survey with a structured questionnaire and a four-week diary were used to collect information on illnesses, health seeking behaviour and socioeconomic factors. Three communes in a mountainous district in Northern Vietnam were selected and a random sample of 1,452 individuals in 300 households was drawn. Results: Self-medication was most common (57%) while 30% used public health services when suffering from a health problem. Persons living far from health services attended public health services less frequently than the others (adjusted OR=0.28; 95% CI 0.15-0.51). This was especially the case for ethnic minorities who were less likely to use public health services than the others were (adjusted OR=0.47; 95% CI 0.25-0.87). Persons with mild conditions tended to use public health services less than those with more severe conditions (OR=0.19; 95% CI 0.10-0.37). Health services use was similar among women and men, but the total expenditure per visit was higher for men. Almost no patients supposed to get free attendance had been exempted from user fees. Conclusions : It was found that there was a geographical inequity in use of public health services while there was relatively equal use of these services between social, gender, and ethnic groups. Long distance in combination with failure of the fee exemption may increase inequity in use of health services in remote and isolated areas. These observations contribute to the basis for implementation of the Vietnamese health policy, emphasizing efficiency and equity.

Keywords

fees for service health services use inequity Vietnam.

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References

Fernandez E. , Schiaffino A. , Rajmil L. , Badia X. , Segura A. Gender inequalities in health and health care services use in Catalonia. J Epidemiol Comm Health 1999; 53: 218-22.

Toan NV , Hoa HT , Trong PV , Höjer B. , Persson LÅ , Sundström K.

Utilisation of reproductive health services in rural Vietnam; are there equal opportunities to plan and protect pregnancies?

J Epidemiol Comm Health 1996; 50: 451-5.

Kaufman J. , Zhirong Z. , Xinjian Q. The quality of family planning services in rural China. Stud Fam Plann 1992; 23: 73-84.

Nyonator F. , Kutzin J. Health for some? The effects of user fees in the Volta Region of Ghana . Health Policy Plann 1999; 14: 329-41.

Cooper H. , Smaje C. , Arber S. Use of health services by children and young people according to ethnicity and social class: secondary analysis of a national survey. Br Med J 1998; 317: 1047-51.

O'Donnell O. , proper C. Equity and distribution of UK National Health Service Resources. J Health Econ 1991 ; 10: 1-19.

Blaxter M. Equity and consultation rate in general practice. Br Med J 1984; 288: 1963-7.

Winnie C.Y. , Wang H. , Yuanli L. Determinants of patient choice of medical provider: a case study in rural China. Health Policy Plann 1998; 13: 311-22.

Guldner M. Health care in transition in Vietnam: equity and sustainability. Health Policy Plann 1995; 10: 49-62.

10.

General Statistic Office. Vietnam living standard survey 1993-1998 . Hanoi: Statistic Publishing House , 1998: 70-85.

11.

Ministry of Health. Health statistic yearbook 1997. Hanoi: Medical Publishing House, 1998: 60-7.

12.

Khe N.D. Equity in health cares in one rural area in Vietnam. MPH thesis. Stockholm: Karolinska Institutet, 1999: 18.

13.

Toan NV , Khe ND , Trong LN , Höjer B. Health expenditure in rural, Vietnam: actual direct cost and payment sources for treating respiratory infections. Manuscript, 2000 .

14.

Tuong NV , Phong DN , Khang LV , Thien DD , Dan TV , Hung NN , Toan NV Changes in health sector during Doi Moi in Vietnam (1987-1998). Research report . Hanoi: Ministry of Health, 1999.

15.

Dean A.D. , Dean J.A. , Columbier D. Epi info, version 6.04. Atlanta: Centre of Disease Control and Prevention, 1994.

16.

Norusis M.J. SPSS for Windows: advanced statistics, 6.0. Michigan : SPSS Inc., 1993.

17.

Alijunid S. The role of private medical practitioners and their interactions with public health services in Asian countries. Health Policy Plann 1995; 10: 333-49.

18.

Cortinovis I. , Vella V. , Nkidu J. Construction of socio-economic index to facilitate analysis of health data in developing countries. Soc Sci Med 1993; 36: 1087-97.

19.

Henderson G. , Akin J. , Zhiming L. , Zhiming L. , Shuigao J. , Haijang M. , Keyou G. Equity and utilisation of health services: report of an eight-province survey in China. Soc Sci Med 1994; 39: 687-99.

20.

Nemet GF , Bailey AJ Distance and health care utilisation among the rural elderly. Soc Sci Med 2000; 50: 1197-8.

21.

Mooney C. , Zwanziger J. , Phibbs CS , Schmitt S. Is travel distance a barrier to veterans' use of VA hospital for medical surgical care. Soc Sci Med 2000; 50: 1743-55.

22.

Bronstain JM , Morrisey MA Determinants of rural travel for obstetrics care. Med Care 1990; 28: 853-65.

23.

Tipping G. , Segall M. Using a longitudinal illness record to study household health care decision making in rural communes of Vietnam. Health Policy Plann 1996; 11: 206-11.

24.

Henderson GE , Akin JS , Hutchinson SG , Jin SG , Wang JM , Dietrich J. , Mao LM Trends in health services utilisation in eight provinces in China, 1989-1993. Soc Sci Med 1998; 47: 1957-71.

25.

Standing H. Gender and equity in health sector reform programmes: a review. Health Policy Plann 1997; 12: 1-18.

26.

Carla AG , Clyde RP Gender, psychosocial factors and the use of medical services: a longitudinal analysis. Soc Sci Med 1999; 48: 1363-72.

27.

Thoson A. , Hoa NP , Long NH Health seeking behaviour of men and women with a cough for more than three weeks (submitted).

28.

Vo Nhai People Committee. Report on socio-economic development 1997 in Vo Nhai. Thainguyen: unpublished.

29.

World Bank. World development reports 1993. Oxford: Oxford University Press, 1993.

30.

Stafield B. , Budetti PP Child health status and risk factors . Health Serv Res 1985; 19: 817-25.

31.

Bruijnzeels MA , Forster M. , Wouden JC Measuring morbidity of children in the community: a comparison of interview and diary data. Int J Epidemiol 1998; 27: 96-100.