Patterns and determinants of health service utilization in rural Thailand : a case study of Nakorn Sawan

Abstract

This study looks at patterns and determinants of curative health service utilization of the rural population of Nakorn Sawan. A statistically representative survey was conducted covering 25 villages, 620 households and 1803 illness events ; multi-level data collection included community, household and individual variables. Qualitative data collection included participant observations and in-depth interviews was also held in 4 sample villages. This data set provided an appropriate interpretive analysis of health behavior patterns collected by the survey. Results show that people were making decisions about health service utilization on a rational basis. Simple and less expensive treatments at lower level health services were first utilized. If first treatments were unsuccessful, higher level services were then utilized.

Logit regression analyses were applied to determine factors that predicted health service utilization behaviors. The determinants of type of first source of treatment, seeking a second source of treatment or not, and type of second source of treatment were identified.

The first source of treatment was determined by indicators of government health policies, characteristics of population at risk, and community characteristics.

Unlike the determinants of first source of care, the probability of seeking a second source of treatment or not was heavily depended upon need factors. Two other factors involved the decision were age and type of first source of treatment.

Characteristics of population at risk and community determined the second source of treatment.

Some interesting findings were having a non-farming household head increased the probability of seeking first treatment from private clinics or hospitals. Fatalistic beliefs of wife of household head decreased the probability of firstly seeking the government hospitals and private clinics or hospitals and secondly seeking the private health services whereas beliefs in spirits increased the probability of seeking self treatment, non-institutional practitioners and health centers as the first and second source of treatment. In addition, the "wealthtier" the community, the more likely people were to seek government health services for the first treatment and private clinics or hospitals for the second source. Lastly, the more bustrips to and from the community, the more ill-persons were likely to seek institutional practitioners as their second source.

Rational choice in selecting health services allows us to predict people's utilization behaviors with some degree of confidence. The central government should support the rational choice process by providing a better and more comprehensive information and communication channels through the health education programs for the general population, special target groups and through the mass media.

Specialized training programs for government health care providers should also be provided to reduce the existing communication problems and social distance between the providers and the consumers.

Additionally, government should pay more attention to the private sector health services since they are so popular and utilized by the rural people.