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 COMMUN[.]
INSTITUTE OF SOCIAL STUDIES NATIONAL UNIVERSITY OF HCM UNIVERSITY OF ECONOMICS THE HAGUE THE NETHERLANDS VIETNAM 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 of the 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 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 of the 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 CERTIFICATION I certify 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 HUYNH DANG BICH VY 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 of what 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-associo-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 of CHC services in order to satisfy particular income group TABLE OF CONTENTS CHAPTER 1: INTRODUCTION I 1.1.PROBLEM STATEMENT 1.2 RESEARCH OBJECTIVES 1.3 RESEARCH QUESTIONS 1.4 METHODOLOGY 1.5 HYPOTHESIS 1.6 RESEARCH SCOPE 1.7 THESIS STRUCTURE CHAPTER 2: LITERATURE REVIEW 2.1.DEFINITIONS 2.2 THEORY OF CONSUMER BEHAVIOR 2.3 THEORIES OF FACTORS AFFECTING HEALTH CARE DEMAND 2.4.MODEL 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 of the 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 of the 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 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 of out-patient health service contacts of each level of income people at each type ofprovide 25 TABLE 4.0: Appropriate sample size 29 TABLE 4.1: The number and the percentage ofobservations for 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 of the 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 of observations 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 of using CHC provider if having change in -ageCJrlevel-of-education;-given-otherfactors ;-;;-=;-.-;-;-;~-.-.-;-;-;-;;-;,-;o.;;-;-;-;;~-.=•• ••- ,••,-.-.-.-.-.•••••••• 44-TABLE 4.14: The changes in the probability ofCHC usage of male and female if age increases by one year, given other factors 45 TABLE 4.15: The changes in the probability ofCHC usage of male and female if the ratio ofdistance increase by one unit, given other factors 45 TABLE 4.16: The changes in the probability ofCHC usage ofmale and female if the user fee ofCHC is cheaper, given other factors 46 TABLE 4.17: The changes in the probability of CHC usage if changing severity of illness, given other factors 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 LIST OF FIGURES FIGURE 2.1: The behavioral model FIGURE 2.2: Choice ofa health care provider 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 outpatient facility used 25 ACRONYMS CHC Commune Health Center GSO General Statistics Office LHS Left Hand Side MOH Ministry of Health MTEF Medium-Term Expenditure Framework RHS Right Hand Side SD Standard Deviation UNDP United Nations Development Programme UNICEF United Nations Children's Fund VDR Vietnam Development Report VLSS Vietnam Living Standards Survey VNHS Vietnam National Health Survey WB World Bank WHO World Health Organization 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 of an 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 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 of people 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 Table 3.1: Infrastructure in three levels of public health care system in 2006 in Vietnam Level Infrastructure Provincial • 304 general and specialist provincial hospitals located throughout 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 District • 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 Commune • 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 of Asian research, 2006 While the only source of funding 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 of Asian research, at the end of2006 a total of only 34,702,000 people had health insurance coverage (41% of Vietnam's population) Although health insurance has been an important source of funds, it is not a fund for CHC 23 Figure 3.4: Proportion of out-patient health service visits by type of provider II] CHC 5.97% 32.01% • District Hospital ~rovincial/Central Hospital 8:1Private Practitioner 7.85% • Other Source: Vietnam National Health Survey 2001-2002 Figure 3.4 shows the proportion of out-patient health service visits by type of provider 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 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 Table 3.2: The proportion of out-patient health service contacts of each level of income people at each type of provider District CHC/ Living standard quintile Provincial/ polyclinic hospital Central Private Other health hospital service facility 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 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 32.6 31.8 34.0 4.0 19.1 0.2 •Only heath care facility in locality 23.6 1.6 0.2 •Convenient/ nearty 28.6 11.8 27.0 • Trust in cuality 1' 35.7 30.6 oOther resson •ReQistered health insuranc3 at this f:~cility Private 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 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 of network of commune 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 of CHC usage 26 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 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 The formula of sample size for a proportion in Godman (1985, p.314) is used: n= Where: n: sample size n: sample proportion Z1: Standard normal value corresponding to the desired level of confidence (y) A: is the required accuracy The value 1t is unknown, and lies between zero and 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 Table 4.0: Appropriate sample size Level of confidence 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 of the 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 selfmedication) 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 of individuals 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 of zero 29 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 of one; 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 Frequency 51 Percent 33.11 HEALTH PHARMACY OTHERS FACILITY VISITS 23 40 40 14.93 25.97 25.97 Source: Author's calculations 4.2.3 Independent variables - 4.2.3.1 Socio-demographic charactenstics - 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 of married 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 of ethnic 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 Table 4.2: Basic socio-demographic characteristics of the respondents Non-CHC CHC Both (n= 103) (%) (n= 51) (%) n= 154 (%) Female 58 0.63 31 0.69 100 0.65 Male 45 0.37 20 0.31 54 0.35 16-30 24 0.23 17 0.33 41 0.27 31-55 57 0.55 18 0.35 88 0.57 56-85 22 0.22 0.32 25 0.16 1-5 46 0.45 30 0.59 76 0.49 6-9 26 0.25 10 0.2 36 0.23 10-16 31 0.3 11 0.21 42 0.28 Married 80 0.78 33 0.65 113 0.73 Unmarried 23 0.22 18 0.35 41 0.27 0.1 0.18 19 0.12 Gender Age Education Marital status Religion status Religion 10 - Non-religion - - - - - - - - - - 93 0.9 42 0.82 135 0.88 Kinh 102 0.99 51 100 153 0.99 Chinese 0.01 0 0.01 Insured 17 0.17 32 0.63 49 0.32 Uninsured 86 0.83 19 0.37 105 0.68 Race Insurance Source: Author's calculations 31 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 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 Unit: VND/month 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 of measuring 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 Table 4.4: Mean individual income of :five groups Variable Mean Std Dev Min Max INC1 59419.35 62833.52 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 of provider by income quintile Non-CHC CHC Both (n=103) (n=51) (n=154) INC1 19 12 31 INC2 19 10 29 INC3 22 30 INC4 25 34 INC5 18 12 30 Variables Source: Author's calculations 4.2.3.3 The characteristics of the perceived illness The number of days of illness and of limited activity Following Trivedi (2003), the author defined the concepts of characteristics of the perceived illness The number of days of illness (IDAY) is the total days an individual confronts with illness but the severity of sickness not effect on respondent's job, activities The higher severity of illness indicated in the variable ''the number of days of limited activity" (RDAY) makes people spend time on sick leave or spend bed-bound 33 Table 4.6: Results of the survey chc and non-CHC respondents in terms of IDAY Valid Valid Cumulative Frequency Percent Percent Percent 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 5.8 5.8 68.8 6.00 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 1.3 1.3 89.6 14.00 1.3 1.3 90.9 15.00 3.9 3.9 94.8 16.00 6 95.5 20.00 6 96.1 30.00 2.6 2.6 98.7 - - -50.00 - -L - - - _ _ - - - - 60.00 6 Total 154 100.0 100.0 - 99.4 - 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 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 (RDAY) that about 19% respondents must be absent from work or study are from to while the average of this variable is just 1.32 days (in table 4.18) Table 4.7: ofRDAY Valid Results of the survey chc and non-CHC respondents in terms Tải FULL (84 trang): https://bit.ly/3PRzYfi Dự phòng: fb.com/TaiHo123doc.net Valid Cumulative Frequency Percent Percent Percent 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 5.2 5.2 92.2 4.00 6 92.9 5.00 1.9 1.9 94.8 7.00 1.9 1.9 96.8 10.00 6 97.4 14.00 1.3 1.3 98.7 30.00 6 99.4 40.00 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 Drug availability Bedi et al (2003) said that quality of services 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 of CHC provider This variable "drug availability" is defined as dummy ones If an 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 not know any thing about this information, the variable "drug availability" will be denoted the score of zero Basing on the data collected, the author estimates in table 4.8 that shows the people's opinions about the availability of drugs in the CHC Table 4.8: Availability of drugs in the CHC Non-CHC CHC Both (n= 103) (%) (n= 51) (%) n= 154 (%) Available 66 64 39 76 105 68 Not available 37 36 12 24 49 32 Drug availability (DRUG) 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 Tải FULL (84 trang): https://bit.ly/3PRzYfi Dự phòng: fb.com/TaiHo123doc.net Information about the distance illustrated in table 4.18 (in appendix) was The distance collected basing on two cases: Case : 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 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 of the 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 of two kinds of cost Specifically, if the respondent's answer is cheaper, these variables will be assigned a score of one; and the score of zero represents the others Table 4.9: Total expenditure for consultation and drugs Non-CHC (n= 103) CHC (%) (n= 51) Both (%) - User fee n= 154 - - - (%) - - - - RCONS CHC cheaper 44 0.43 42 0.82 86 0.56 Not cheaper 59 0.57 0.18 68 0.44 CHC cheaper 43 0.42 43 0.84 86 0.56 Not cheaper 60 0.58 0.16 68 0.44 RPRICE Source: Author's calculations Table 4.9 shows the results of the survey of the 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 ... 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... 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... 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,