Effecting of educational level on self medication decition of patients in hochiminh city

NATIONAL UNIVERSITY OF HCM INSTITUTE OF SOCIAL STUDIES UNIVERSITY OF ECONOMICS THE HAGUE VIETNAM THE NETHERLANDS VIETNAM-THE NETHERLANDS PROJECT ON DEVELOPMENT ECONOMICS EFFECT OF EDUCATIONAL LEVEL ON SELF-MEDICATION DECISION OF PATIENTS IN HOCHIMINH CITY A thesis submitted in partial fulfillment of the requirements for the degree of MASTER OF ARTS IN DEVELOPMENT ECONOMICS By PHAM QUANG ANH THU Academic Supervisor: DR NGUYEN VAN NGAI HO CHI MINH CITY, AUGUST 2007 ACKNOWLEDGEMENTS The author would like to express sincere thanks and special thanks to the academic supervisor Dr Nguyen Van Ngai for his assistance and suggestion during the writing of this thesis I am grateful to Dr Nguyen Trong Hoai, Dr Nguyen Hoang Bao and Dr Arjun Singh Beddi for their useful comments on thesis proposal and thesis drafts which are helpful to the author in doing the thesis I also express my special thanks to M.A Truong Dang Thuy, without his regular and precious advices the author could not complete the research Great appreciation is expressed to my classmates, Quyen and Vy, for their honest friendship, enthusiastic support and sharing during studying at the Vietnam — Netherlands Program for M.A in Development Economics Sincere thanks go to my family for their spiritual encouragement and material support which helped me overcome all difficulties during pursuing my M.A program Last but not least, many thanks are given to the households who allowed the author to interview them CERTIFICATION Icertify that the substance of this 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 PHAM QUANG ANH THU Date: 01 August, 2007 ABSTRACT Self-medication is a common practice in many developing countries In Vietnam, self-medication has grown in recent years due to the increasing availability of drug vendors and pharmacy shops throughout the country Beside the convenience, time and cost saving, self-medication is associated with risks such as misdiagnosis, use of irrational drug dosage that lead to the harmful consequences not only for patient himself but also for community as a whole Investigating the determinants of selfmedication practice of individuals facing illness is helpful for the health policy makers who are interested in improving the appropriate access of self-medication in public This study focuses on examining the impact of educational level on self-medication practice in Ho Chi Minh city, the national center of educational and health care of the country The descriptive statistics and econometric analyzes have been applied to answer the question whether the adult individuals with a higher education are more likely to be self-medicated The thesis has been employed the theory of consumer choice as the foundation theory, the Andersen’s behaviour model, and two empirical studies to construct a health-seeking model which describes the way individuals make choices regarding health care utilization to get the highest level of utility The findings based on the survey conducted by the author in Ho Chi Minh city show that the more educated individual is, the more self-medication he or she has in treating minor illness TABLE OF CONTENTS CHAPTER 1: INTRODUCTION 1.1 PROBLEM STATMENT 1.2 RESEARCH OBJECTIVE, RESEARCH QUESTION & RESEARCH HYPOTHESIS 1.3 RESEARCH METHODOLOGY 1.4 THE ORGANIZATION OF THE THESIS CHAPTER 2: LITERATURE REVIEW .6 2.1 SOME DEFINITIONS / Self-medication /.2 Professional health care provider / Types of illnesses 2.2 THEORETICAL FRAMWORK 2.2 Theory of consumer behaviour and the demand for health care services 2.2.2 Grossman's theory ofhuman capital and the demand for health care .’ 12 2.2.3 Andersen’s behaviour model and access to medical care 15 2.3 EMPiRICAL STUDIES / 2.3 / Chang and Trivedi (2003) /8 2.3.2 Arjun 5.Bedi et at (2003) /9 2.4 MODEL SPECIFICATION 21 / Empirical model .23 2.4.2 Transforming theoretical framework into variables 26 2.4.2 / Dependent variable 4.2 Independent variables 27 2.5 CONCLUSloN .32 CHAPTER 3: VIETNAMESE HEALTH CARE AND DRUG UTILAZATION 34 HEALTH CARE UTILIZATION IN VIET NAM 34 3.I Trends in health care seeking behaviour of individuals .34 .2 The Cost of Health Serv/ces 35 / Self-medication and reasons 38 3.2 DRUG UTILAZATION & SOURCE OF DRUGS FOR SELF-MEDICATION IN VIET NAM 40 3.2 / National drug policy .42 3.2.2 Antibiotic resistance .43 3.3 CONCLUSION 44 CHAPTER 4: SELF-MEDICATION BEHAVIOUR OF PATIENTS IN HO CHI MINH CITY .46 OVERVIEW OF HO CHI MINH CITY - THE NATIONAL CENTER OF EDUCATION & HEALTH CARE 46 4.2 DATA COLLECTING METHOD 48 4.3 DESCRIPTIVE STATISTICS 50 4.3 / Individual characteristics 51 4.3.2 Price and attributes of health care providers 55 4.3.3 Knowledge of drug safety ofrespondents .5 4.4 ECONOMETRIC ANALYSES 60 4 / Methods of interpretation 60 4.4.2 Explanations ofregression results .62 CHAPTER S: CONCLUSIONS AND RECOMMENDATIONS .66 5.1 CONCLUSIONS 66 5.2 RECOMMENDATIONS 68 REFERENCES: 71 APPENDICES: 78 APPENDIX 1: 78 APPENDIX 2: .86 APPENDIX 3: .87 LIST OF FIGURES FIGURE 2.1: Available health consumption bundlafor individuals with different health status .10 FIGURE 2.2: Effect of income ‹›n provider choice 11 FIGURE 2.3: Effect of price ‹›n provider cholce 11 FIGURE 2.4: Andersen ’s Behavioural Model 16 FIGURE 3.1: Selected reason for self-medication by age group .38 LIST OF TABLES TABLE 2.1: List ofvariables and expected signs 26 TABLE 3.1: Annualized health services contact rates, by provider 34 TABLE 3.2: Distribution of total health services contacts across providers in 1998 5$ TABLE 4.1: Description of variables .51 TABLE 4.2 Demographic Information of Respondents by behaviour group ••• .$2 TABLE 4.3: Changing in choosing health care providers of Group 54 TABLE 4.4: Total cost of treatment by behaviour group 55 TABLE 4.5: Total consuming time of treatment by behaviour group 56 TABLE 4.6: Knowledge of drug safety by behaviour group 57 TABLE 4.7: Knowledge of drug safety by behaviour and educational group $9 ACRONYMS GSO General Statistics Office United Nations UNDP United Nations Development Programme VHI Vietnam Health Insurance VHSR Vietnamese Health Sector Review VLsS Vietnam Living Standards Survey VNHs Vietnam National Health Survey VNDP Vietnamese National Drug Policy World Bank World Health Organization CHAPTER 1: INTRODUCTION 1.1 PROBLEM STATEMENT After the economic reforms initiated in 1986 in Vietnam, the role of public health sector began to deteriorate which accompanied the emergence of private sector and the expanding of pharmaceutical industry Between 1986 and 1994 there was a three-fold increase in drug production and a six-fold increase in per capita drug consumption (Witter, 1996) The rapidly expanding drug vendors and pharmacy shops throughout the country have emerged now acting as an important health care provider Data from Vietnam Living Standard Survey 1997-1998 (VLSS, 1997-1998) indicates that the contact rate with the health care system was dominated by the use of pharmaceuticals According to the VLSS 2001-2002, self-medication is very common practice to deal with illness among Vietnamese households - 73 percent of patients reporting use of self-medication to deal with illness and most people procure medication for self-medication at pharmacists The common practice of self-medication has both positive and negative aspects In cases of common illness, such as coughs or colds, selfmedication may be rational behaviour in terms of convenient, time saving and cheap if patients have sufficient knowledge about common nonprescription drugs But in cases of more serious disease, requiring the use of antibiotics or steroids, or in cases of special status such as pregnancy, babies, people with Sam C., Tornquist I Bjorn Wenngren, Nguyen Thi kim Chuc, Mattias Larsson, Einar magnusson, Nguyen Thanh Do, Pham Van Ca and Le Dang Ha (1993) 'Antibiotic resisstance in Vietnam:An epidemiological indicator of inefficient and inequitable use of health resources', Household Welfare and Vietnam ’s Transition, edited by Dollar D, et a1 World Bank Regional and Sectoral Study, The World Bank, Washington, DC, 235-256 Tomquist, C., Wenngren, B., Chuc, N T., Larsson, M., Magnusson, E and Do, N (2000), In Efficient, equity-oriented strategies for heath-international perspectives-focus on Vietnam (Eds, Hung, P., Minas, H., Liu, Y., Dahlgen, G and Hsiao, W.) CIMH, Melbourne, pp 139-164 Trivedi PK (2003), “Patterns of health care utilisation in Vietnam: Analysis of 1997-1998 VLSS”, World Bank Policy Research Working Paper UN (2003) “ Vietnam: Economic Development Indicators, 1995-2000” http://www.un.org/esa/population/publications/countrvprofile/vietnan i.pdf, accessed on 20 February , 2007 Van Duong, D.V., Binns, C.W., & Le, T.V (1997) "Availability of antibiotics as over-the counter drugs in pharmacies: A threat to public health in Vienam" Tropical Medicine & International Health, 2(12), 1133 - 1139 VNHS (2001-2002), http://www.moh.gov.vn/solieu/defaultE.htm, accessed on 20 August, 2006 Weller, S.C., Ruebush II, T.R and klein, R.E (1997), "Predicting treament-seeking behaviour in Guatemala: A Comaprison of The Health Servics researhc and Decision-Theoretic approaches", Medical Anthropology Quarterly Vol 11: 224-245 Witter S (1996) “Doi moi and health: The effect of economic reforms on the health system in Vietnam”, the International journal of health planning and 75 management, I 1:159-172 Wolffers, I (1995) "The role of pharmaceuticals in the privatization proces in Vietnams health care system", Social Science and Medicine, 41 (9), 1325 - 1332 World Bank (1987),"Financing Health Services in Developing Countries: An Agenda for Reform", World Bank Policy study, Washington D.C World Bank (1993) World Development report Investing in health World Band Publications, Washington World Bank (2001) "Vietnam Growing Healthy - A Review of Vietnam’s Health Sector" World Bank Publications, 2001 WHO (1995) "Report of the WHO Expert Committee on national Drug Policies", World Health Organization, Geneva WHO (2001a) “Global Strategy for Containment of Antimicrobial Resistance”, World Health Organization, Geneva WHO (200lb) “Guidelines for the regulatory assessment of Medicinal Products for use in self-medication” WHO Drug Inform 2001, World Health Organization, Geneva 76 APPENDICES APPENDIX I HOUSEHOLDS QUESTIONAIRE CODE: District: Ward/Commune: Address: Tel: Date of interview: / /2007 PART I: KNOWLEDGE AND ATTITUDE QUESTIONS You can discontinue the use of antibiotics by yourself when the symptoms of illness are relieved Agree k Don’t know/ No idea O Disagree You can buy your own antibiotics without prescription? Agree nDon’t know/ No idea n Disagree When having old symptoms of disease, you can buy medicine following the previous prescription Agree l Don’t know/ No idea O Disagree You have to use up medicine bought follow prescription recommended by doctor Agree ODon’t know/ No idea D Disagree You have to follow-up examination according to recommendation of doctor Agree D Don’t know/ No idea D Disagree According to you, antibiotics should be used in which cases of illnesses? Diarrhoea without fever Yes Infection, inflame Yes Fever, headache Yes O ODon’t know/ No n idea ODon’t know/ No n No No know/ No idea idea No nDon’t 77 Stomachache Yes O No D Don’t know/ No idea O No k Don’t know/ No idea 10 Cough, cold, headache Yes 11 Have you ever treated yourself according to advices from your friends/relationships who are not doctors/ nurses? Yes No 12 Do you consult your pharmacist about the using of medicine when you have some diseases? Yes NNoo 13 Do you have a health insure card? Yes No 14 In the past of previous months, you suffer from any of the below diseases? (multi-selection is allowed) O Angina O Gastritis (/\/oIe Stop interviewing if respondent have had any diseases) PART II: ILLNESSES AND TREATMENTS 15 For how many days have you suffered from this 16 In this period of being ? .days , which ways did you choose to treat: (multi-selection is allowed) a Buy drug without any prescription from physician/Self-medication b Go for examination in public health care facilities O c Go for examination in private health care facilities d Not seek any medical services (go to the other disease) 17 According to you, this is: D a Very slight O b Slight D c Minority 78 d Severe D e Very severe 18 In total, how many times did you choose self-medicated and visiting doctor in this sickness period? times * Note for interviewer (1) One i/me ofself-medication is when respondent buy medicine without any prescription from physician to treat, or buy medicine with an old prescription, (2) One time of examining and treating medically is going for examination in any health care facilities, buying and using this prescriptive medicine 19 In this sickness period, please tell in each time of treatment you chose: O First times Second times Third times Fourth times Fifth times Self- O Self- O Self- O Self- O Self- medication D Visiting medication D Visiting doctor doctor medication n Visiting doctor medication D Visiting medication D Visiting doctor doctor * Note for interviewer (according to information question 19) a If respondent chose visiting doctor only, go to question 20, b If respondent chose visiting doctor after one7some times self-medication, go to ques//on 22; c If respondent did not have any visiting doctor, go to question 24 20 According to you, is the times of being illness longer if you had not have visited doctor? Yes No Not sure 21 If yes, how many days is it longer? days (Go to Part III) 22 According to you, is it shorter if you had have visited doctor from beginning? Yes No Not sure 23 If yes, how many days is it shorter? days (Go to Part III) 24 According to you, is it shorter if you had have visited doctor? Yes No Not sure 25 If yes, how many days is it shorter? days (Go to Part III) 79 PART III: QUESTIONS ABOUT PHARMACY, HEALTH CARE PROVIDER * Note for interviewer according to information question 19, chose the suitable following part Part III Part III Part III Part III a Self-medication only b Visit doctor only c Both a & b PART III.I: QUESTIONS ABOUT PHARMACY/DRUG STORE 26 At which pharmacies did you buy medicine? (multi-selection is allowed) D a Near your house D b Near your company n c Most frequent pharmacy d Others, please specify the reasons: 27 In this sickness period, if you had self-medication more than one time, did you buy medicine at the same pharmacy/drug store? Yes (Go to question 29) No 28 If you bought medicine at different pharmacies, please tell at which pharmacies you buy most frequently (chose one option) D a Near your house n b Near your company k c Most frequent pharmacy d Others, please specify the reasons: 29 How many minutes did it take you to buy medicine? minutes * Note for interviewer The time is two-way time (go to pharmacy, buying medicine and coming back) What mean of transport did you use mainly to go to pharmacy? a On foot $ b Bicycle c Motorbike O d Others 31.What was the total self-medication cost in this treatment period? * Note for interviewer The total self-medication cost does not include the cost of buying prescriptive medicine PART III.2 QUESTIONS ABOUT CLINIC/HOSPITAL 32 At which health care providers did you go for examination and treatment during this period? (multi-selection is allowed) O a Near your house O b Near your company O c Most frequent clinic/hospital d Insurance registered clinic/hospital O e Well-reputation clinic/hospital f Others, please specify the reasons: 33 Did you use your health insurance card? Yes No 34 If you visited doctor more than one time, did you go for examination and treatment at the same place during this sickness? Yes (Go to question 36) No 35 If you visited doctor at different health care providers, please tell at which did you go most frequently (chose one option) n a Near your house O b Near your company O c Most frequent clinic/hospital d Insurance registered clinic/hospital D e Well-reputation clinic/hospital f Others, please specify the reasons: 36 How many minutes did it take you to go to that health care provider? minutes * Note for interviewer The time includes time of going to health care provider and come back 37 How many minutes did it take you to wait at health care provider before seeing doctor? minutes 81 * Note for interviewer the waiting time excludes the time for testing, and X-ray checks 38 How many minutes did the examination take you? minutes 39 What mean of transport did you use mainly to go to pharmacy? a On foot $ b Bicycle c Motorbike d Others 40 What was the total cost of all consultations in this treatment period? VND 41 What was the total cost of buying medicine follow prescription of doctor for all examinations? VND * Note for interviewer The total cost of buying medicine without any prescription from physician to treat, or buy medicine with an old prescription is excluded 42 Did you buy medicine at pharmacy where you took examination? Yes (Stopfor this part) No 43 If no, at which pharmacy did you buy medicine? (Chose one suitable option) $ a Near your house D b Near your company $ c Most frequent pharmacy e Others 44 Did you bought medicine immediately after leaving health care provider? Yes (Stopfor this part) No 45 How many minutes did it take you to buy medicine? minutes * Note for interviewer The time is two-way time (go to pharmacy, buying medicine and coming back) 46 What mean of transport did you use mainly to go to pharmacy? a On foot O b Bicycle c Motorbike d Others 82 PART III.3: QUESTIONS ABOUT PHARMACY lsk this part in case of respondent chose using health care providers for examination and treatment only 47 It’s supposed that in this time of sickness, you thought that it was not too severe to visit doctor but self-medication only, at which pharmacy would you buy medicine? (Chose one suitable option) D a Near your house O b Near your company O c Most frequent pharmacy d Others, please specify the reasons: 48 Is it the pharmacy that you mentioned in question 26 or at the health care provider where you went for examination? Yes (Go to question 51) No 49 How many minutes did it take you to buy medicine? minutes * Note for interviewer The time is two-way time (go to pharmacy, buying medicine and coming back) 50 What mean of transport did you use mainly to go to pharmacy? O a On foot O b Bicycle O c Motorbike d Others 51 You think that what the total cost of buying medicine would be? VND PART III.4: QUESTIONS ABOUT CLINIC/HOSPITAL Ask this part in case the respondent chose using self-medication only 52 It’s supposed that in this time of sickness, you thought that it was relative severe, you would go for examination and treatment not self-medication, at which health care provider would you chose? (Chose one suitable option) D a Near your house D b Near your company O c Most frequent clinic/hospital d Insurance registered clinic/hospital n e Well-reputation clinic/hospital f Others, please specify the reasons: 53 You think that how many minutes it takes you to go to that health care provider? minutes * Note for interviewer It includes the time of going to health care provider and come back 54 What mean of transport did you use mainly to go to pharmacy? a On foot D b Bicycle c Motorbike d Others 55 How many minutes did it take you to wait at health care provider before seeing doctor? minutes * Note for interviewer the waiting time excludes the time for testing, and X-ray checks 56 How many minutes did the examination take you? minutes 57 You think that what the total cost of all consultation would be? (Excluding the cost of buying medicine following the prescription) PART IV: GENEARE INTERVIEWEE INFORMATION Please tell me your: 58 Full name: 59 Age: 60 Sex: Male Female 61 Ethnicity: a Kinh b Chinese c Others (specify): 62 Your current marital status: Single Married Widowed n Divorced/Separated 84 63 What is the grade has you finished? D Grade ./12 Vocational Graduated Studying College: O Studying University Graduated Studying O Higher than university Graduated O O No formal schooling 64 What are the total years you went to school? years (Note interviewer compare question 65, excluding years respondents repeated class) 65 For which economic sector you work for? $ a State company/enterprise O b Private company/enterprise c Joint venture with foreign company d Self-employed/Free occupation e Housewife/Househusband f Unemployment g Student 66 Please tell me the average monthly of your income bracket is: a Less than 500.000 VND i From 4.000.000 to 4.500.000 VND b From 500.000 to 1.000.000 VND D j From 4.500.000 to 5.000.000 VND c From 1.000.000 to 1.500.000 VND e From 2.000.000 to 2.500.000 VND k From 5.000.000 to VND 5.500.000 D From 5.500.000 to VND 6.000.000 m From 6.000.000 to 6.500.000 VND f From 2.500.000 to 3.000.000 VND n From 6.500.000 to 7.000.000 VND From 3.000.000 to 3.500.000 VND n o From 7.000.000 to 7.500.000 VND d From 1.500.000 to 2.000.000 VND From 3.500.000 den 4.000.000 VND D p From 7.500.000 to 8.000.000 VND O q More than 8.000.000 VND 67 Do you own this house/apartment or? Rent Own 68 The total area is: m2 85 69 Please tell me how many items you own for each of the following? Items Washing machine Air conditioner Refrigerator Water heater Car Check x if yes 70 How much was your electricity bill last month? VND APPENDIX 2: Results of question about Knowledge of drug safety Agree Questions Not know/ No idea No Question 68 57% 13 11% 39 Ouestion 37 31% 6% 76 63% Ouestion 82 68% 15 13% 23 19% Question 96 80% 6% 17 14% Question 100 6% 13 11% Question 33 28% 32 27% Cluestion 93 78% 10 Ouestion 61 51% 11 Question 42 35% 27 Question 10 71 59% 14 9% 12% Number ofrespondents ——120 Source Author’s calculation from household survey 2007 46% 17 14% 48 40% 51 43% 29% APPENDIX 3: Correlation using correlate command in Stata choice edu gender age marred dayill choice 1.0000 edu 0.3010 1.0000 age -0.3300 -0.2327 1.0000 gender -0.2404 -0.1652 -0.0867 1.0000 married -0.3406 -0.2488 0.4100 -0.0800 1.0000 dayill -0.2973 -0.1332 0.2939 0.1262 0.1843 1.0000 difpri 0.2021 -0.0281 -0.1137 0.0047 -0.0460 -0.0354 diftime 0.2670 0.2446 -0.0548 -0.1531 -0.0690 -0.1365 quality -0.2097 0.0234 0.0828 -0.0605 0.0999 0.0792 ins -0.3879 -0.1971 0.3510 0.1340 0.3890 0.3345 difpri diftime quality difpri 1.0000 diftime 0.2347 1.0000 quality -0.0079 -0.1895 1.0000 ins -0.1128 0.0251 0.0319 ins 1.0000 87 ... self- medication in public This study focuses on examining the impact of educational level on self- medication practice in Ho Chi Minh city, the national center of educational and health care of. .. households - 73 percent of patients reporting use of self- medication to deal with illness and most people procure medication for self- medication at pharmacists The common practice of self- medication. .. Designing effective interventions can not be done without understanding factors impact on self- medication behaviour of people In this study we focus on finding out the influence of educational level