Examining the treatment choice when getting a cold

MINISTRY OF EDUCATION AND TRAINING UNIVERSITY OF ECONOMICS HO CHI MINH CITY VIETNAM Examining the Treatment Choice When Getting a Cold By DANG HOANG HAI TRUONG MASTER OF ARTS IN DEVELOPMENT ECONOMICS (SPECIALIZATION IN HEALTH ECONOMICS AND MANAGEMENT) HO CHI MINH CITY, MAY 2015 MINISTRY OF EDUCATION AND TRAINING UNIVERSITY OF ECONOMICS HO CHI MINH CITY VIETNAM Examining the Treatment Choice When Getting a Cold A thesis submitted in partial fulfillment of the requirements for the degree of MASTER OF ART IN DEVELOPMENT ECONOMICS (SPECIALIZATION IN HEALTH ECONOMICS AND MANAGEMENT) Major: Economics Code: 60310105 By DANG HOANG HAI TRUONG Academic Supervisor: Dr NAM KHANH PHAM HO CHI MINH CITY, MAY 2015 CERTIFICATION STATEMENT I guarantee data used in this thesis were truly collected through survey progress, along with using legal documents The implications are withdrawn by the author from the experience of working, and learning HoChiMinh city, 2nd May 2015 Dang, Truong Hoang Hai Abstract Wrong decision leads to wrong destination We make choice at every action in our life There are a lot of decisions that are over our knowledge or experience Sometimes we need a convincer who knows better However it is difficult for us to judge whether his decision will lead to our expected outcome He also does not know what factors we are considering That is the reason why sometimes we make an irrational decision which is from other’s point of view For a convincer, it is important to understand decision factors of person who is convinced In health aspects, doctor-patient communication is significantly vital For a health authority, if he wants people to make a decision that benefit to the whole society, he also should understand their elements of consideration This thesis studies treatment decision making of patients when they get a cold Our survey shows that people have three kinds of decision when they get a cold i.e either “go to the doctor”, or “self-medication” or “non-drug treatment” This thesis examines the impacts of psychological factors and socio-economic factors on each of the decisions The social pressure and patient’s perceived control factors not have influence on the decision Females who have higher education are more likely to go to the doctor, and who have high income are less likely to choose self-medication We employed the multivariate probit model to analyze the treatment choice and a factor analysis to construct psychological variables which were developed from the Theory of Planned Behavior ACKNOWLEDGEMENTS This thesis would not be completed without the backing and the encouragement of important individuals First, I would like to say thanks to my instructor, Dr Pham Khanh Nam, in spite of his busy schedule, he guided me to finish this dissertation Second, I would like to say my gratitude to my parents who encouraged me in hard moments and their unconditional love Third, it would be a mistake if I did not make mention to my friends and my brother who helped me to sharpen the questionnaire Finally, I express my gratitude to participants who play an important role in this thesis through their collaboration to complete the questionnaire ABBREVIATIONS Freq Frequency RUM Random Utility Maximization TPB Theory of Planned Behavior VND Vietnam dong WHO World Health Organization Table of Contents CHAPTER 1: INTRODUCTION………… …………… … ……………… 1.1 Research problems.……………….…………………………………….1 1.2 Research objectives…………………………………… ………… … 1.3 Scope of study………………………………………………………… 1.4 The structure of the thesis…………………………………………… CHAPTER 2: LITERATURE REVIEW………………………… ……….… .4 2.1 Key Concepts………………………… ………….… ……….………4 2.1.1 Common health problems and common cold…….……………4 2.1.2 Patient choice and its special elements……….…………… 2.1.3 Patient belief……………… ………………………………….4 2.1.4 Self-medication and economics of self-medication………… 2.1.5 Non-drug treatment…… …………………………………… 2.1.6 Social capital… … …………………………………………6 2.2 Studies of socio-economic factors in health aspect……… ……… 2.3 Theory of Planned Behavior in Health Choice……………………… 10 2.4 Review of empirical studies …………………………………………11 2.5 Literature review conclusion………………………………………….12 CHAPTER 3: RESEARCH METHODOLOGY……… …………………… …13 3.1 Analytical framework……………………………………………….…13 3.2 Measurement of variables ………………………………………… 15 3.2.1 Qualitative process………………………………………… 15 3.2.2 Quantitative process……………… ……………………… 18 3.2.2.1 Indirect measure of the Theory of Planned Behavior…….18 3.2.2.2 Direct measure of the Theory of Planned behavior 21 3.2.2.3 Socio-economic………………………………………… 22 3.3 Econometric Models………………………………………………… 22 3.4 Variable description………………… …………………………… 24 3.5 Research strategy …………………………………………………… 29 3.5.1 Setting………….…………………………………………….29 3.5.2 Sampling technique and sample size…………………………30 3.5.3 Data collection process……………………………………….30 3.5.4 Data analysis…………………………………………………31 3.5.5 Data framework… ………………………………………… 31 CHAPTER 4: RESEARCH RESULTS……… ……………… ….… ……… 32 4.1 Overview of Vietnamese health environment………………… …… 32 4.2 Descriptive statistics……………………………………….………… 32 4.2.1 Psychological factors statistic…………………… …………33 4.2.1.1 Attitude……………………… …………………….33 4.2.1.2 Subjective norm…………………………………….36 4.2.1.3 Perceived behavioral control……………… ………37 4.2.2 Socio-economic statistic…………………………………… 38 4.2.2.1 Demographic variables…………………………… 38 4.2.2.2 Descriptive social capital variables…………………40 4.2.2.3 Descriptive risk variables………………………… 41 4.3 Regression results……………….…………………………………… 42 4.3.1 Theory of Planned Behavior…………… ………………… 42 4.3.1.1 Indirect measure…………………………………….42 4.3.1.2 Direct measure…………………………………… 49 4.3.2 Socio-economic factors………………… ………………… 51 CHAPTER 5: CONCLUSIONS AND POLICY IMPLICATIONS…… .55 5.1 Conclusions…… ………………………… ………………… …55 5.2 Policy Implications…………………… ……………….…… …… 56 5.3 Other suggestions…….………….…………………….…… ……… 57 5.4 Limitation…………… ………………………………… ………… 58 REFERENCES.………………………………………………….… ………… 59 APPENDIX A……… ………………………………………………………… 64 APPENDIX B………………………………………………… ……….….……71 LIST OF FIGURES Figure Model of the study…………… ……………………… …………… 13 Figure Data framework………………………………………… …………….31 Figure The income and the choice……………………………………… … 39 Figure The gender and the choice…………………………………… ……….40 Figure The social group adherence and the choice………………………… …42 LIST OF TABLES Table Theories of socio-economic in health aspect…………….……………….9 Table Salient belief items……………………………………………………….18 Table Variables definition………………….………………………………… 25 Table The statistical results of the choice……………………….………………33 Table The attitude and the choice…………….…………… ………………… 35 Table The subjective norm and the choice…………………… ……………… 37 Table The perceived behavioral control and the choice…………………………38 Table Descriptive demographic variables……………………………………….38 Table Joint social group……………………….……………………………… 40 Table 10 Description of trust…………….……………………………………… 41 Table 11 Risk attitude description……………….……………………………… 41 Table 12 Factor analyses and Cronbach’s alpha of the indirect measure…….… 43 Table 13 Multivariate probit regression of indirect measure………………….… 47 Table 14 Factor analyses and Cronbach’s alpha of the direct measure………… 49 Table 15 Multivariate probit regression of direct measure……….………………50 Table 16 Factor analyses and Cronbach’s alpha of the socio-economic………….51 Table 17 Multivariate probit regression of socio-economic……….…………… 52 CHAPTER 1: INTRODUCTION 1.1 Research problems: In a big picture, there is an unbalanced diversity among hospitals There is a very common situation that in central hospitals, such as Cho Ray hospital, hospital overload is the serious trouble that causes two patients have to share one bed However in the others hospital, like district hospitals or private hospitals, there are usually free beds as a result of lacking of patients The ability of “downstream” hospitals, by doubting not only about technique ability but also service ability could damage deeply in patient’s belief Even when they can completely cure the common diseases, people still want to stay away and move to higher level hospitals There is information asymmetry between the patients and medical staffs For instance, patients not know whether drugs they are using are good or bad for their health and also not know which are the good sides and which are the drawbacks of the medicine services that they are consuming as well as the opportunity cost they have to pay when they could get to other hospitals or choose to not experience in medical care Moreover, until now in medicine area, for a certain health problem, we still not have powerful measure tools to predict which doctor, or drug, is better and completely guarentee for a positive outcome There are chances existing, chances for getting cured, and chances for complication The result is mostly on individual basis, which one experiences himself as a patient or who know the patient, don’t know thoroughly about the situation In this lack of information and uncertainty environment, individual seems to make a choice between various solutions by their feeling and belief Health is a vital matter for each individual Good health allows us to live and work more efficiently and positively Bad health on other hand could negatively affect people attitude and productivity That is the reason why an increase in level of citizens’ health can improve the productivity, GDP, research, or education so that the social community can be enhanced in all areas In the other side of the coin, when a health problem 57 wastes the hospital’s resource The waiting is the opportunity cost of more necessary patients about matters like time, doctor’s examination Understanding common cold patient’s beliefs about the inconvenience, time costing and their consider of money when they choose doctor solution, medical authority can increase the price of doctor service, make the waiting time for healthcare progress longer, or make it more difficult to approach for them in highly overload hospitals They can choose others options such as self-medication or non-drug treatment Moreover, based on this thesis’s results, a development of pharmacy system in both quality and quantity, educating people about related health knowledge, let them know how to consume medicine, how to self-care effectively, and when they have to go to the doctor, will reduce the number of patients go to the doctor as well as the hospital This way can reduce the overload in central hospitals For patients, they can save their money, time, and also reduce the risk of getting more serious diseases in central hospital environment For medical staffs in district hospitals, or lower stage health centers, they have more patients to serve, so they can sharpen their talent The more influent medical staffs in their career, the more likely people will belief in them and less likely to go to central hospitals For medical staffs in central hospitals, they can concentrate to patients who required deeper medical-skill In conclusion, patients with common health problem are out number but they required less skillful manpower And the less skillful manpower costs lower social resource An effective distribution of patients and medical-staffs helps built the better social 5.3 Others suggestions: In the operation, sometime the participant wrote down their thought in the sample In general, they complained about Vietnamese health system in dimensions: facility, people, and policy They also proposed solutions for the system Health service is mostly complained Medical staff’s attitude when communicating with patient and patient’s relative is bad, it make them unhappy They suggested the improvement in the service, as well as communication skill for medical staffs They 58 also believed that service in private hospital is much better in government hospital Bribery is another important issue Reducing bribery is expected to enhance people’s trust in healthcare system Hospital overload is considered as a big drawback to hospital identified To let people drop in a certain hospital or clinic, inform people about the situation in this health center promise a positive outcome Time waiting in the healthcare operation is mentioned a lot in the sample People want to reduce the time in the progress The healthcare cost is complained high compared with their income 5.4 Limitations: A drawback of this thesis is the sampling Cluster sampling is chosen because of its advantage in the cost, time, and approach However, cluster sampling need to consider “design-effect” to decide the number of the sample For a better result, it should be altered by random sampling The elicitation results from pilot test not include the effective outcome as well as the demand for health of the choice This could be explained that because of the number of samples in pilot test does not represent the population For a complete solution of Vietnamese hospital overload, a more detail on 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(You can choose many answers) a Go to the doctor b Self-medication c Non-drug treatment When you get a cold, with your choice to recover, what you feel? Bad: -3 : -2 : -1 : : : : : Good Unsatisfied: -3 : -2 : -1 : : : : : Satisfied A About going to the doctor: A1 Please write down the number respect to your level of agreement in each statement: Go to the doctor is: -3 Extremely disagree -2 Very disagree -1 Disagree Neither agree nor disagree Agree Very agree Extremely agree A Inconvenience B Much money costing C Time costing A2 65 -3 Extremely disagree -2 Very disagree -1 Disagree Neither agree nor disagree Agree Very agree Extremely agree A Inconvenience is dissatisfied B Much money costing is not necessary C Time costing is not necessary B1 Please write down the number respect to your level of agreement in each statement: Self-medication is: -3 Extremely disagree -2 Very disagree -1 Disagree Neither agree nor disagree Agree Very agree Extremely agree A Convenience B Time saving B2 -3 Extremely disagree -2 Very disagree -1 Disagree Neither agree nor disagree Agree Very agree Extremely agree A Convenience is satisfied B Time saving is necessary C1 Please write down the number respect to your level of agreement in each statement: Non-drug treatment is: 66 -3 Extremely disagree -2 Very disagree -1 Disagree Neither agree nor disagree Agree Very agree Extremely agree A Better life style B Using less medicine C Improving immune system D Rising body protection ability C2 -3 Extremely disagree -2 Very disagree -1 Disagree Neither agree nor disagree Agree Very agree Extremely agree A Better life style is helpful B Using less medicine is helpful C Improving immune system is helpful D Rising body protection ability is helpful Please write down the number respect to your level of agreement in each statement: -3 Extremely disagree -2 Very disagree -1 Disagree Neither agree nor disagree Agree Very agree Extremely agree A Most people approve your choice B Your family approves your choice C Your friends approve your choice D Your co-workers approve your choice E Medical staffs approve your choice F Most people perform like your choice 67 G Your family performs like your choice H Your friends perform like your choice I Your co-workers perform like your choice J Medical staffs perform like your choice Please write down the number respect to the impact of your referents on your decision in each statement: Extremely unlikely Very unlikely Unlikely Neither unlikely nor likely Like Very likely Extreme likely A Family B Friends C Co-workers D Medical staffs When I get a cold, I am confident that I can perform my choice: False: : : : : : : : True Please write down the number respect to your level of agreement in each statement: -3 Extremely disagree -2 Very disagree -1 Disagree Neither agree nor disagree Agree Very agree Extremely agree A I think it is not convenient to perform my choice B I think perform my choice may lead to more serious outcome When you perform your choice, does each element below make it easy or difficult? 68 -3 Extremely difficult -2 Very difficult -1 Difficult Neither difficult nor easy Easy Very easy Extremely easy A Not convenience B Disease more serious Did you attend to any social group? ☐ No, I did not ☐ Yes, I did 10 Please write down the number respect to your level of agreement in each statement -3 Extremely disagree -2 Very disagree -1 Disagree Neither agree nor disagree Agree Very agree Extremely agree A Every one surrounding is trustable B Nobody surrounding harm you because of their benefit C Every one surrounding helps you when you need D It is not wise to lend people surrounding 11 Please write down the number respect to your level of agreement in each statement -3 Extremely disagree -2 Very disagree -1 Disagree Neither agree nor disagree Agree 69 Very agree Extremely agree A I trust shopkeepers B I trust local government officers C I trust central government officers D I trust police E I trust teachers F I trust nurses, doctors G I trust strangers 12 How often you buy lottery? ☐ Never ☐ Rarely ☐ One per week ☐ Many time per week ☐ Every day Demographic Data What is your age? years old What is your gender? ☐ Female ☐ Male What is your marital status? ☐ Single ☐ Married How many people live in your house? 70 people What is your level of education? ☐ Lower element school ☐ Element school ☐ Junior school ☐ High school ☐ Higher than high school What is your income per month? ☐ Lower VND million ☐ VND million to VND 10 million ☐ VND 10 million to VND 20 million ☐ Higher VND 20 million 71 Appendix B: ELICITATION Demographic characteristics Name Gender Year of bird Occupation Work place Insurance How many times you get an illness? Marital status Questions Choice Experiential ATT What is your treatment decision when getting a cold? What you feel? Do you hate or like this decision? What benefits of this choice? Instrumental ATT What is its disadvantage? Who will approve your choice? Normative influence Who will not approve? What make it easier for you to perform this decision? Perceive control What make it more difficult? ... believe are the advantages of your choice when you get a cold? b What you believe are the disadvantages of your choice when you get a cold? Salient normative beliefs: 16 a Are there any individuals... demographic characteristic, social capital and risk behavior The demographic characteristics consist of gender, age, education, married, family, and income 15 Social capital: social capital is measured... choice: Patient’s treatment choices are their solutions when getting a cold They are “go to the doctor”, self-medication, and non-drug treatment Patient’s choice is analyzed by asking them choose their