Health Policy and Planning Advance Access originally published online on September 5, 2008
Health Policy and Planning 2008 23(6):397-407; doi:10.1093/heapol/czn034
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Taking account of context: how important are household characteristics in explaining adult health-seeking behaviour? The case of Vietnam
1 Department of Economics, University of Manitoba, Winnipeg MB R3T 5V5, Canada.
2 Health Policy Branch, Health Canada, Ottawa ON K1A 0K9, Canada.
* Corresponding author. Department of Economics, University of Manitoba, Winnipeg MB R3T 5V5, Canada. Tel: +1–204–474 6241. Fax: +1–204–474 7681. E-mail: sepehri{at}cc.umanitoba.ca
Understanding the factors affecting the utilization of health services is essential for health planners, especially in low income countries where increasing access to and use of health services is one of the main policy goals of government. While much has been written on adult health-seeking behaviour, there is comparatively little known about the influence of the broader context such as the effects of family and community on individual use of health care services in low income countries. Using Vietnam's latest National Household Survey data, this paper empirically assesses the influence of individual- and household-level factors on the use of health care services, while controlling for the unobserved household-level effects. The estimates obtained from a multilevel logistic regression model suggest that the individual's likelihood of seeking treatment is jointly determined by the observed individual- and household-level characteristics as well as unobserved household-level effects. The chance of seeking medical treatment when ill varies strongly with the observed individual- and household-level covariates, including health insurance status, income, the type and severity of illness, the number of other household members with an ailment and the presence of young children in the household. However, the variability implied by the unobservable household-level effects outweighs the variability implied by the observed covariates, indicating a high degree of homogeneity in health-seeking behaviour among the household members. Failure to take account of homogeneity in health-seeking behaviour among the household members leads not only to biased results but also to inefficient policy targeting. Policies aimed at increasing access to and the use of medical services need to be sympathetic to both individuals and households.
Key Words: Health-seeking behaviour, multilevel analysis, unseen barriers to access, Vietnam
Accepted for publication 21 June 2008.
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