(Luận văn) 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 ng THE NETHERLANDS VIETNAM hi ep VIETNAM-THE NETHERLANDS PROJECT ON DEVELOPMENT ECONOMICS w n lo ad ju y th yi pl ua al n EFFECT OF EDUCATIONAL LEVEL ON va n SELF-MEDICATION DECISION OF PATIENTS ll fu oi m IN HOCHIMINH CITY at nh z z A thesis submitted in partial fulfillment of the requirements for the degree of vb MASTER OF ARTS IN DEVELOPMENT ECONOMICS k jm ht BO.GIAo ovc ~At: :., TAo- TRUdNG fJH KINH ,.:: T~ l.c PHAM QUANG ANH THU gm By 'c · 1~.HCM TI:!_li VIiJ~'N om Academic Supervisor: n va DR NGUYEN VAN NGAI 6~Zr; an Lu ey t re a th HO CHI MINH CITY, AUGUST 2007 ACKNOWLEDGEMENTS ng hi ep The author would like to express sincere thanks and special thanks to the academic w n supervisor Dr Nguyen Van Ngai for his assistance and suggestion during the lo ad writing of this thesis ju y th yi I am grateful to Dr Nguyen Trong Hoai, Dr Nguyen Hoang Bao and Dr Arjun pl n ua al Singh Beddi for their useful comments on thesis proposal and thesis drafts which n va are helpful to the author in doing the thesis fu ll I also express my special thanks to M.A Truong Dang Thuy, without his regular oi m at nh and precious advices the author could not complete the research z Great appreciation is expressed to my classmates, Quyen and Vy, for their honest z vb l.c gm Netherlands Program for M.A in Development Economics k jm ht friendship, enthusiastic support and sharing during studying at the Vietnam - Sincere thanks go to my family for their spiritual encouragement and material om n va program an Lu support which helped me overcome all difficulties during pursuing my M.A ey t re Last but not least, many thanks are given to the households who allowed the author th a to interview them 11 CERTIFICATION ng I certify that the substance of this thesis has not already been submitted for hi ep any degree and is not being current submitted for any other degree w n lo ad ju y th 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 yi pl ua al n PHAM QUANG ANH THU va n Date: 01 August, 2007 ll fu oi m at nh z z k jm ht vb om l.c gm n a Lu n va y te re a th 111 ng hi ABSTRACT ep w n Self-medication is a common practice in many developing countries In Vietnam, lo ad self-medication has grown in recent years due to the increasing availability of drug ju y th vendors and pharmacy shops throughout the country Beside the convenience, time yi and cost saving, self-medication is associated with risks such as misdiagnosis, use pl of irrational drug dosage that lead to the harmful consequences not only for patient ua al himself but also for community as a whole Investigating the determinants of self- n n va medication practice of individuals facing illness is helpful for the health policy ll fu makers who are interested in improving the appropriate access of self-medication oi m in public nh at This study focuses on examining the impact of educational level on self-medication z z practice in Ho Chi Minh city, the national center of educational and health care of vb jm ht the country The descriptive statistics and econometric analyzes have been applied k to answer the question whether the adult individuals with a higher education are gm more likely to be self-medicated The thesis has been employed the theory of l.c consumer choice as the foundation theory, the Andersen's behaviour model, and om two empirical studies to construct a health-seeking model which describes the way an Lu individuals make choices regarding health care utilization to get the highest level n va of utility a iv th in treating minor illness ey show that the more educated individual is, the more self-medication he or she has t re The findings based on the survey conducted by the author in Ho Chi Minh city TABLE OF CONTENTS CHAPTER 1: INTRODUCTION ng 1.1 1.2 1.3 1.4 hi ep PROBLEM STATMENT RESEARCH OBJECTIVE, RESEARCH QUESTION & RESEARCH HYPOTHESIS RESEARCH METHODOLOGY THE ORGANIZATION OF THE THESIS CHAPTER 2: LITERATURE REVIEW w n lo 2.1 SOME DEFINITIONS 2.1.1 Self-medication 2.1.2 Professional health care provider 2.1.3 Types of illnesses 2.2 THEORETICAL FRAMWORK 2.2.1 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 : l2 2.2.3 Andersen's behaviour model and access to medical care 15 2.3 EMPIRICAL STUDIES 17 2.3.1 Chang and Trivedi (2003) 18 2.3.2 Arjun S.Bedi eta! (2003) 19 2.4 MODEL SPECIFICATION 21 2.4.1 Empirical mode/ 23 2.4.2 Transforming theoretical framework into variables 26 2.4.2.1 Dependent variable 27 4.2.2 Independent variables 27 2.5 CONCLUSION 32 ad ju y th yi pl n ua al n va ll fu m CHAPTER 3: VIETNAMESE HEALTH CARE AND DRUG UTILAZATION 34 oi at nh HEALTH CARE UTILIZATION IN VIETNAM 34 3.1.1 Trends in health care seeking behaviour ofindividuals ; 34 3.1.2 The Cost of Health Services 35 3.1.3 Self-medication and reasons 38 3.2 DRUG UTILAZATION & SOURCE OF DRUGS FOR SELF-MEDICATION IN VIETNAM 40 3.2.1 National drugpolicy 42 3.2.2 Antibiotic resistance 43 3.3 CONCLUSION 44 z z jm ht vb CHAPTER 4: SELF-MEDICATION BEHAVIOUR OF PATIENTS IN HO CHI MINH CITY 46 k om l.c gm 4.1 OVERVIEW OF HO CHI MINH CITY- THE NATIONAL CENTER OF EDUCATION & HEALTH CARE 46 4.2 DATACOLLECTINGMETHOD 48 4.3 DESCRIPTIVE STATISTICS • , 50 3.1 Individual characteristics 51 4.3.2 Price and attributes ofhealth care providers 55 4.3.3 Knowledge of drug safety ofrespondents 57 4.4 ECONOMETRIC ANAL YSES 60 4.1 Methods of interpretation 60 4 Explanations ofregression results 62 n a Lu va CHAPTER 5: CONCLUSIONS AND RECOMMEND ATIONS 66 n CONCLUSIONS 66 RECOMMENDATIONS • 68 y REFERENCES: 71 te re 5.1 5.2 th a APPENDICES: 78 APPENDIX 1: 78 APPENDIX 2: 86 APPENDIX 3: 87 v LIST OF FIGURES ng hi ep FIGURE 2.1: Available health consumption bundleJfor individuals with different health status ••• • •.•.•• 10 FIGURE 2.2: Effect of income on provider choice ••••••••••••.••••••••••• ••••••••••••••• • •••••••••••.•••••••••• •••••.•••••• 11 w FIGURE 2.3: Effect ofprice on provider choice ••.•.•.•.•••••••••••.••••••••••••• ••••••••••• • •.•••••••.•.•••••••••••.•.••••.•••••• 11 n FIGURE 2.4: Andersen's Behavioural Model •.•.•.•••••••• •••••••••.•.•.•.••••••••••.••••••••••••.• ••••••• •.••••••••••• •.• 16 lo ad FIGURE 3.1: Selected reason for self-medication by age group •.•.••••••••••••••••••••••••••••.••••••• ••••••.•••••.•••.•.••• 38 ju y th LIST OF TABLES yi pl al TABLE 2.1: List ofvariables and expected signs •.••••••••••••.••.•••••••••••.••••••••••.••••••••••••••.•.•.•••••• ••••••••••••.•••.•• 26 n ua TABLE 3.1: Annualized health services contact rates, by provider •••••••••.••.•.•••••••••.••.••••••.• ••••••••• •.••••••• 34 TABLE 3.2: Distribution oftotal health services contacts across providers in 1998 ••••••••.•••••••• •.••••••••.••.• 35 va n TABLE 4.1: Description ofvariables •••.•••.•••••••••• •••••••••• •.•••••••••.• ••••••••• •••••••••••.••••••••• ••••••••.••.•••••• 51 ll fu TABLE 4.2: Demographic Information of Respondents by behaviour group ••••••.•.••••••.•• •••••••••••.•••••••••.•.• 52 m TABLE 4.3: Changing in choosing health care providers ofGroup •••••••• •••••••••• •.••••••••••.•.•••••••••.••.•••••• 54 oi TABLE 4.4: Total cost oftreatment by behaviour group• • •.• • •.•.•.• • • •.• • .• • •• • •.•.• 55 nh TABLE 4.5: Total consuming time of treatment by behaviour group •••••• •••••••••••.•.••••••••••• •.•••••••.• ••••••• 56 at TABLE 4.6: Knowledge of drug safety by behaviour group •••••.• •••••••••••••••••••••••.••••••••••••.•.••••••• •••••••••• 51 z z TABLE 7: Knowledge of drug safety by behaviour and educational group •.•••••••••• ,•.••••••••••.••.•••••••••.•••••• 59 k jm ht vb om l.c gm n a Lu n va y te re a th vi ACRONYMS ng hi ep w General Statistics Office UN United Nations UNDP United Nations Development Programme n GSO lo Vietnam Health Insurance VHSR Vietnamese Health Sector Review VLSS Vietnam Living Standards Survey ad VHI ju y th yi Vietnam National Health Survey pl VNHS Vietnamese National Drug Policy WB World Bank WHO World Health Organization n ua al VNDP n va ll fu oi m at nh z z k jm ht vb om l.c gm n a Lu n va y te re a th vii CHAPTER 1: INTRODUCTION ng hi ep 1.1 PROBLEM STATEMENT w After the economic reforms initiated in 1986 in Vietnam, the role of public n lo ad health sector began to deteriorate which accompanied the emergence of ju y th private sector and the expanding of pharmaceutical industry Between 1986 yi and 1994 there was a three-fold increase in drug production and a six-fold pl ua al increase in per capita drug consumption (Witter, 1996) The rapidly n expanding drug vendors and pharmacy shops throughout the country have n va ll fu emerged now acting as an important health care provider Data from oi m Vietnam Living Standard Survey 1997-1998 (VLSS, 1997-1998) indicates nh that the contact rate with the health care system was dominated by the use of at z z pharmaceuticals According to the VLSS 2001-2002, self-medication is very vb jm ht common practice to deal with illness among Vietnamese households - 73 k percent of patients reporting use of self-medication to deal with illness and gm most people procure medication for self-medication at pharmacists om l.c The common practice of self-medication has both positive and negative n y te re patients have sufficient knowledge about common non-prescription drugs va may be rational behaviour in terms of convenient, time saving and cheap if n a Lu aspects In cases of common illness, such as coughs or colds, self-medication a steroids, or in cases of special status such as pregnancy, babies, people with th But in cases of more serious disease, requiring the use of antibiotics or drug allergies, the treatment without consultation of medical professionals ng can lead to harmful consequences In the latter cases, self-medication hi ep accompanied the lack of ability or awareness of the need to read the drug w information lead to a risky of wasting money, status of sickness may be more n lo ad serious The negative sides of self-medication not only affect the individuals ju y th but also the community The large scale drug resistance in the community of yi Vietnam has increased and reached epidemic levels (Sam, 1993) The future pl ua al potency of drug for all users is reduced, which has lead to increasing the n amount of treatment failures, and as the result, leading to longer and more n va ll fu severe illness and demand for more expensive drugs This result has oi m increased financial burden on the poor and those without any medical nh knowledge a further reduction in equity (WHO, 2001a) at z z ht vb The promotion of the rational drugs use to minimize the negatives effects on k jm the public health when the self-medication practice is prevalence in Vietnam gm is the emerging concern of health policy makers Designing effective om l.c interventions can not be done without understanding factors impact on selfmedication behaviour of people In this study we focus on finding out the n a Lu influence of educational level on self-medication behaviour of patients in Ho va n Chi Minh city, one of the biggest city of the country y te re ac th 1.2 RESEARCH OBJECTIVE, RESEARCH QUESTION AND ng hi RESEARCH HYPOTHESIS ep Research objective w n lo On the demand side, the knowledge, attitudes, and education of an individual ad ju y th are important determinants in the decision to seeking health care The most yi important purpose of this study is to examining the impacts of educational pl ua al level of the adults on their self-medication when being illness n The influences of other sociodemographic factors, attributes of health care n va ll fu provider on self-medication behaviour of patients in Ho Chi Minh city are oi m also included in order to support the health policy makers who are interested nh in improving the appropriate access of self-medication in public at z z Research Question and Research Hypothesis ht vb k jm It's realised that education level enhances the ability of accessing and l.c gm criticising information of people Therefore, an individual with high educational level is expected that might have high self-confidence about his om medical knowledge which results in having more self-medication than lower an Lu educational person Hence, this dissertation attempts to answer the question: Are adult individuals with higher years of schooling more likely to be n va - ey t re self-medicated facing typical diseases? a th And the research hypothesis is: GSO (1999) Vietnam Living Standards Survey 1997-1998 General Statistical ng office, Hanoi hi ep Gujarati D.N (2003) Basic Econometrics, McGraw-Hill, 2003 w Ha, N (1991), "Resistance to antibiotics in enteric bacteria from patients with n lo diarrhoea and healthy persons in Vietnam and characterization of beta ad lactamases in eschericha coli", (Thesis) Academic Department, Karolinska y th ju Institutet, Stockholm yi pl Ho Chi Minh GSO (2005), Statistical Yearbook Ho Chi Minh city, Statistical office al n ua ofHo Chi Minh city (Vietnamese version) n va Hogerzeil, H V (1995) Promoting rational prescribing: an international ll fu perspective British journal of clinical pharmacology, 39:1-6 m oi Jac,k, W (1993) "The Demand for health Care Services", Principles of Health nh Economics for Developing countries, WB I Development Studies, at z Washington, DC, 55-79 z vb jm ht James H, Handu SS, Al Khaja KAJ, Otoom S, and Sequeira RP (2006), "Evaluation of the Knowledge, Attitude and Practice of Self-Medication Medical Medical Principles and om l.c Practice, 15:270-275 Students", gm First-Year k among Kafle KK and Gartulla RP (1993) "Self-medication and its impact on essential an Lu drugs schemes in Nepal" n va http://library.searo.who.int/modules.php?op=modload&name=websis&file= t re wholisdoc&from=wholisdoc 1&show= 16607&with=Self0/o20medication, ey accessed on 16 August, 2006 73 ac Care Demand in Benin", Working Paper, Laval University th Lacriox, Guy and E.Alohonou (1982), "An Empirical Model of Primary Health Lavy, Victor, and Jean-Marc Germain (1994), "Quality and cost in Health Care ng Choice in Developing Countries", Living Standards Measurement Study hi Paper No 105 World Band, Washington D.C ep Litvack, Jenny I and Claude Bodart (1993), "User Fees plus Quality equals w n improved access to Health care: Results of a Field Experiment in Camroon", lo ad Social Science and Medicine Vol 37:369-383 y th ju Long,J.S(1997), Regression Models for Catergorical and Limited Dependent yi Variables, London & New Delhi: Sage Publications pl al ua Lonnroth, K (2000) "Public health in private hands: studies on private and public n tuberculosis care in Ho Chi Minh City", Vietnam, Goterborg n va oi m International Edition ll fu Mason, D.R (1999), Statistical techniques in business and economics, McGraw-Hill nh Mwabu, G.M, Ainsworth, M., and Nyamete A (1994), "Quality of Medical Care at z and Choice of Medical Treatment in Kenya: An Empirical Analysis", z ht vb Journal of Human Resources Vol 28: 83 8-862 k jm Okumura J, Wakai S, Umenai T (2002), "Drug utilisation and self-medication in l.c gm rural communities in Vietnam", Social Science and Medicine, 54:1875 Pagan, J.A, Ross S., Jeffrey Y and Danniel P (2005) "Self-medication and Health om Insurance coverage in Mexico" an Lu http://www.pop.upenn.edu/rc/parc/aging center/2005/PARCwps05-02.pdf, n va accessed on 25 September, 2007 ey t re ac th 74 Sam C., Tornquist I Bjorn Wenngren, Nguyen Thi kim Chuc, Mattias Larsson, ng Einar magnusson, Nguyen Thanh Do, Pham Van Ca and Le Dang Ha (1993) hi 'Antibiotic resisstance in Vietnam:An epidemiological indicator of ep inefficient and inequitable use of health resources', Household Welfare and w Vietnam's Transition, edited by DollarD, et al World Bank Regional and n lo Sectoral Study, The World Bank, Washington, DC, 235-256 ad y th Tornquist, C., Wenngren, B., Chuc, N T., Larsson, M., Magnusson, E and Do, N ju (2000), In Efficient, equity-oriented strategies for heath-international yi pl perspectives-focus on Vietnam (Eds, Hung, P., Minas, H., Liu, Y., Dahlgen, al n ua G and Hsiao, W.) CIMH, Melbourne, pp 139-164 n va Trivedi PK (2003 ), "Patterns of health care utilisation in Vietnam: Analysis of ll fu 1997-1998 VLSS", World Bank Policy Research Working Paper (2003) " Vietnam: Economic Development Indicators, 1995-2000" oi m UN on 20 February, 2007 at nh http://www un org/esa/population/publications/countryprofi le/vietnam.pdt: accessed z z vb Van Duong, D.V., Binns, C.W., & Le, T.V (1997) "Availability of antibiotics as jm ht over-the counter drugs in pharmacies: A threat to public health in Vienam" k Tropical Medicine & International Health, 2(12), 1133- 1139 gm VNHS (2001-2002), http://www.moh.gov.vn/solieu/defaultE.htm, accessed on 20 om l.c August, 2006 a Lu Weller, S.C., Ruebush II, T.R and klein, R.E (1997), "Predicting treament-seeking n Decision-Theoretic approaches", Medical Anthropology Quarterly Vol 11: n va behaviour in Guatemala: A Comaprison of The Health Servics researhc and te re 224-245 y 75 ac system in Vietnam", The International journal of health planning and th Witter S (1996) "Doi moi and health: The effect of economic reforms on the health management, 11:159-172 ng Wolffers, I (1995) "The role of pharmaceuticals in the privatization proces in hi ep Vietnams health care system", Social Science and Medicine, 41 (9), 1325 - 1332 w n World Bank (1987),"Financing Health Services in Developing Countries: An lo ad Agenda for Reform", World Bank Policy study, Washington D.C y th ju World Bank (1993) World Development report Investing in health World Band yi Publications, Washington pl al n ua World Bank (2001) "Vietnam: Growing Healthy- A Review of Vietnam's Health n va Sector" World Bank Publications, 2001 ll fu WHO (1995) "Report of the WHO Expert Committee on national Drug Policies", oi m Wodd Health Organization, Geneva nh at WHO (2001a) "Global Strategy for Containment of Antimicrobial Resistance", z Wodd Health Organization, Geneva z vb jm ht WHO (200 1b) "Guidelines for the regulatory assessment of Medicinal Products for use in self-medication" WHO Drug Inform 2001, World Health k om l.c gm Organization, Geneva n a Lu n va y te re ac th 76 APPENDICES ng hi APPENDIX ep HOUSEHOLDS QUESTIONAIRE w n lo CODE: ad District: y th W ard!Commune: ju yi Address: Tel: pl Date of interview: I /2007 ua al n PART I: KNOWLEDGE AND ATTITUDE QUESTIONS va n You can discontinue the use of antibiotics by yourself when the symptoms of illness are fu ODon't know/ No idea ODisagree oi Agree m ll relieved Agree ODon't know/ No idea ODisagree z at nh You can buy your own antibiotics without prescription? z vb When having old symptoms of disease, you can buy medicine following the previous Agree ODon't know/ No idea jm ht prescription ODisagree k D Agree ODon't know/ No idea ODisagree You have to follow-up examination according to recommendation of doctor ODon't know/ No idea ODisagree According to you, antibiotics should be used in which cases of illnesses? n ODon't know/ No idea ONo ODon't know/ No idea ONo ODon't know/ No idea te re ONo n va Diarrhoea without fever D Yes a Lu D Agree om l.c gm You have to use up medicine bought follow prescription recommended by doctor Infection, inflame y ac th D Yes Fever, headache D Yes 77 Stomachache Yes ng ONo ODon't know/ No idea ONo ODon't know/ No idea hi 10 Cough, cold, headache ep Yes w n 11 Have you ever treated yourself according to advices from your friends/relationships who lo ad are not doctors/ nurses? y th Yes No ju 12 Do you consult your pharmacist about the using of medicine when you have some yi Yes No o No n ua al pl diseases? va 13 Do you have a health insure card? n Yes ll fu 0 Angina j0 nh (multi-selection is allowed) oi m 14 In the past of previous months, you suffer from any of the below diseases? Gastritis at z (Note: Stop interviewing if respondent have had any diseases) z k jm ht vb PART II: ILLNESSES AND TREATMENTS gm 15 For how many days have you suffered from this _ _ _ _ _? days l.c 16 In this period ofbeing _ _ _ _ _,which ways did you choose to treat: om (multi-selection is allowed) a Buy drug without any prescription from physician/Self-medication c Go for examination in private health care facilities d Not seek any medical services (go to the other disease) b Slight c Minority ac o th a Very slight ts: ey t re 17 According to you, this n va b Go for examination in public health care facilities an Lu 78 d Severe e Very severe ng hi ep 18 In total, how many times did you choose self-medicated and visiting doctor in this sickness period? _ _ _ _ times w *Note for interviewer: (1) One time ofself-medication is when respondent buy medicine n lo without any prescription from physician to treat, or buy medicine with an old ad prescription; (2) One time of examining and treating medically is going for examination y th in any health care facilities, buying and using this prescriptive medicine ju yi 19 In this sickness period, please tell in each time of treatment you chose: pl Second times Self- D D medication D D n doctor Visiting va Visiting Fourth times Self- Self- D medication medication Visiting D doctor Visiting D doctor doctor ll fu doctor Visiting Fifth times Self- D medication n D Self- ua medication Third times al D First times m oi *Note for interviewer (according to information question 19): nh If respondent chose visiting doctor only, go to question 20; If respondent chose visiting doctor after one/some times self-medication, a at z b z vb to question 22; If respondent did not have any visiting doctor, go to question 24 jm ht c go 20 According to you, is the times of being illness longer if you had not have visited k Yes gm doctor? No Notsure l.c om 21 If yes, how many days is it longer? days (Go to Part III) No I Not sure va Yes n a Lu 22 According to you, is it shorter if you had have visited doctor from beginning? n 23 If yes, how many days is it shorter? days (Go to Part III) te re No _l Not sure ac Yes th y 24 According to you, is it shorter if you had have visited doctor? 25 If yes, how many days is it shorter? days (Go to Part III) 79 PART III: ng QUESTIONS ABOUT PHARMACY, HEALTH CARE PROVIDER hi * Note for interviewer: according to information question 19, chose the suitable ep following part w Part /Ill Part Ill2 Part Ill3 Part IIL4 n lo a Self-medication only X ad X b Visit doctor only ju y th X c Both a & b X X X yi pl al QUESTIONS ABOUT PHARMACY/DRUG STORE ua PART 111.1: n 26 At which pharmacies did you buy medicine? (multi-selection is allowed) va a Near your house b Near your company c Most frequent pharmacy d Others, please specify the reasons: _ _ _ _ _ n ll fu oi m nh at 27 In this sickness period, if you had self-medication more than one time, did you buy (Go to question 29) vb Yes z z medicine at the same pharmacy/drug store? No ht c Most frequent pharmacy d Others, please specify the reasons: _ _ _ _ _ te re and coming back) b Bicycle ac th a On foot y 30 What mean of transport did you use mainly to go to pharmacy? n buying medicine va * Note for interviewer: The time is two-way time (go to pharmacy, n 29 How many minutes did it take you to buy medicine? _ _ _ _ _ minutes a Lu b Near your company om l.c a Near your house gm k buy most frequently (chose one option) jm 28 If you bought medicine at different pharmacies, please tell at which pharmacies you D c Motorbike 80 D d Others 31 What was the total self-medication cost in this treatment period? ng * Note for interviewer: The total self-medication cost does not include the cost of hi ep buying prescriptive medicine PART III.2 QUESTIONS ABOUT CLINIC/HOSPITAL w n 32 At which health care providers did you go for examination and treatment during this lo ad period? (multi-selection is allowed) a Near your house D y th D D c Most frequent clinic/hospital D d Insurance registered clinic/hospital D e Well-reputation clinic/hospital D f Others, please specify the reasons: - - - - - - - ju b Near your company yi pl n ua al va n 33 Did you use your health insurance card? fu Yes D No ll D m oi 34 If you visited doctor more than one time, did you go for examination and treatment (Go to question 36) D z Yes at D nh at the same place during this sickness? No z 35 If you visited doctor at different health care providers, please tell at which did you D c Most frequent clinic/hospital e Well-reputation clinic/hospital D f Others, please specify the reasons: _ _ _ _ _ n a Lu D om d Insurance registered clinic/hospital l.c D gm b Near your company k D jm a Near your house ht D vb go most frequently (chose one option) n minutes va 36 How many minutes did it take you to go to that health care provider? _ _ _ y te re *Note for interviewer: The time includes time of going to health care provider and 37 How many minutes did it take you to wait at health care provider before seeing doctor? - - - minutes 81 ac th come back * Note for interviewer: the waiting time excludes the time for testing, and X-ray checks ng 38 How many minutes did the examination take you? minutes hi ep 39 What mean of transport did you use mainly to go to pharmacy? w a On foot b Bicycle n c Motorbike lo ad d Others y th ju 40 What was the total cost of all consultations m this treatment period? yi _ _ _ _VND pl 41 What was the total cost of buying medicine follow prescription of doctor for all VND n ua interviewer: The total cost of buying medicine without any prescription va * Note for al examinations? n from physician to treat, or buy medicine with an old prescription is excluded fu ll 42 Did you buy medicine at pharmacy where you took examination? No oi Yes (Stop for this part) m nh 43 If no, at which pharmacy did you buy medicine? (Chose one suitable option) e Others k jm c Most frequent pharmacy ht vb b Near your company z z a Near your house at 0 Yes (Stop for this part) No l.c gm 44 Did you bought medicine immediately after leaving health care provider? om 45 How many minutes did it take you to buy medicine? _ _ _ _ _ minutes and coming back) n a Lu *Note for interviewer: The time is two-way time (go to pharmacy, buying medicine b Bicycle c Motorbike d Others y te re a On foot n va 46 What mean of transport did you use mainly to go to pharmacy? ac th s 82 PART Ill.3: QUESTIONS ABOUT PHARMACY 4sk this part in case of respondent chose using health care providers for examination and ng hi ~reatment only ep 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? w n (Chose one sui~able option) lo a Near your house b Near your company c Most frequent pharmacy d Others, please specify the reasons: _ _ _ _ _ ad ju y th yi pl ua al 48 Is it the pharmacy that you mentioned in question 26 or at the health care provider where you went for examination? n Yes (Go to question 51) No n va minutes fu 49 How many minutes did it take you to buy medicine? ll * Note for interviewer: The time is two-way time (go to pharmacy, oi m and coming back) buying medicine nh 50 What mean of transport did you use mainly to go to pharmacy? at a On foot b Bicycle c Motorbike d Others z z k jm ht vb PART III.4: gm 51 You think that what the total cost ofbuying medicine would be? VND QUESTIONS ABOUT CLINIC/HOSPITAL om l.c Ask this part in case the respondent chose using self-medication only a Lu 52 It's supposed that in this time of sickness, you thought that it was relative severe, n you would go for examination and treatment not self-medication, at which health d Insurance registered clinic/hospital e Well-reputation clinic/hospital s c Most frequent clinic/hospital ac th b Near your company y te re a Near your house n va care provider would you chose? (Chose one suitable option) 83 D f Others, please specify the reasons: _ _ _ _ _ ng 53 You think that how many minutes it takes you to go to that health care hi provider?_ _ _minutes ep * Note for interviewer: It includes the time of going to health care provider and come back w n 54 What mean of transport did you use mainly to go to pharmacy? lo a On foot D b Bicycle ad D c Motorbike ju yi d Others pl D y th D ua al 55 How many minutes did it take you to wait at health care provider before seeing n doctor? - - - minutes * Note for n va interviewer: the waiting time excludes the time for testing, and X-ray ll fu checks minutes m 56 How many minutes did the examination take you? 57 You think that what the total cost of all consultation would be? oi VND nh at (Excluding the cost of buying medicine following the prescription) z PART IV: GENEARE INTERVIEWEE INFORMATION z ht vb Please tell me your: jm 58 Full name: k 59 Age: D a Kinh c Others (specify): _ _ _ _ _ n va n D b Chinese a Lu om 61 Ethnicity: Female l.c D Male gm 60 Sex: Single y D te re 62 Your current marital status: th ac D Married D Widowed D Divorced/Separated 84 63 What is the grade has you finished? ng hi ep w Grade ./12 Vocational Graduated D Studying College: Graduated D Studying University Graduated D Studying Higher than university n lo No formal schooling ad years y th 64 What are the total years you went to school? ju (Note: interviewer compare question 65, excluding years respondents repeated class) yi 65 For which economic sector you work for? pl a State company/enterprise b Private company/enterprise c Joint venture with foreign company d Self-employed/Free occupation e Housewife/Househusband f Unemployment g Student n ua al n va ll fu oi m at nh z 66 Please tell me the average monthly of your income bracket is: z a Less than 500.000 VND i From 4.000.000 to 4.500.000 VND D b From 500.000 to 1.000.000 VND j From 4.500.000 to 5.000.000 VND D c From 1.000.000 to 1.500.000 VND k From 5.000.000 to 5.500.000 VND D d From 1.500.000 to 2.000.000 VND From 5.500.000 to 6.000.000 VND D e From 2.000.000 to 2.500.000 VND m From 6.000.000 to 6.500.000 VND D f From 2.500.000 to 3.000.000 VND n From 6.500.000 to 7.000.000 VND D g From 3.000.000 to 3.500.000 VND o From 7.000.000 to 7.500.000 VND D h From 3.500.000 den 4.000.000 VND p From 7.500.000 to 8.000.000 VND q More than 8.000.000 VND k jm ht vb D om l.c gm an Lu n va ey t re 67 Do you own this house/apartment or? Own s o ac Rent th 68 The total area is: m2 85 69 Please tell me how many items you own for each of the following? Check x if yes ng Items hi ep Washing machine Air conditioner Refrigerator w Water heater n lo ad Car ju y th 70 How much was your electricity bill last month? VND yi Results of question about Knowledge of drug safety pl APPENDIX2: al n No % No % 57% 13 11% 39 33% 6% 76 63% 15 13% 23 19% 6% 17 14% 6% 13 11% 55 46% 17 14% 48 40% 51 43% 35 29% 68 Question 37 Question 82 68% Question 96 80% Question 100 83% Question 33 28% 32 Question 93 78% 10 Question 61 51% 11 9% Question 42 35% 27 23% Question 10 71 59% 14 12% fu Question nh % ll n va No Disagree Not know/ No idea Agree ua Questions oi m 31% at z z vb 27% ht om l.c an Lu Source: Author's calculationfrom household survey 2007 gm Number ofrespondents=l20 k jm 8% n va ey t re ac th s 86 '\ ·~ ·.t~· APPENDIX 3: Correlation using correlate command in Stata ng hi choice age edu gender married dayill ep w n lo 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 0.2021 -0.0281 -0.1137 0.0047 -0.0460 -0.0354 0.2670 0.2446 -0.0548 -0.1531 -0.0690 -0.1365 0.0828 -0.0605 0.0999 0.0792 0.3510 0.1340 0.3890 0.3345 ad choice ju y th pl -0.2097 0.0234 ins -0.3879 -0.1971 n quality ua al diftime yi difpri n va diftime ll fu difpri quality ins m 1.0000 diftime 0.2347 1.0000 quality -0.0079 -0.1895 1.0000 ins -0.1128 0.0251 0.0319 oi difpri at nh z z k jm ht vb 1.0000 om l.c gm n a Lu n va y te re ac th s 87