Choice of health-care facility after introduction of free essential health services in Nepal
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Date
2013-04
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
WHO Regional Office for South-East Asia
Abstract
Background: Choice of health‑care services depends on patients’ characteristics
and the features of health‑care facilities available. In Nepal, a significant proportion
of health care is provided through the private sector, despite the introduction of free
essential health care for all citizens in 2008. We sought to determine whether people
chose private or public facilities in the first instance for acute health problems. We
also assessed the reasons for their choice.
Materials and Methods: A cross‑sectional survey was done by use of a questionnaire
administered to 400 household heads in Jhapa district, Nepal.
Results: 272 (68%) respondents sought treatment from public health‑care facilities
in the first instance. On adjusted analysis, illiterate people were more likely to
choose public facilities than people with higher secondary education (OR 5.47,
P = 0.002). Similarly, lower‑caste and religious‑minority respondents were more
likely to choose public facilities than disadvantaged janajati (OR 2.33, P = 0.01).
Among respondents who used public facilities, 174 (64.0%) and 109 (40.0%) stated
that that their choice was based on financial accessibility and physical accessibility,
respectively. Among respondents who used private facilities, 65 (50.7%) and
54 (42.1%) said their choice was based on adequacy of resources/services and
health‑care delivery, respectively.
Conclusion: A substantial portion of respondents used public health‑care facilities
in the first instance, mainly because of financial and physical accessibility rather
than adequacy of resources or better health‑care delivery. These results may
indicate a positive impact of removal of user fees for public health‑care facilities
in Nepal, especially for impoverished people.
Description
Keywords
Choice, health‑care facilities, Nepal, user fee
Citation
WHO South-East Asia Journal of Public Health 2013;2(2): 96-100.