Lönnroth K, Thuong L M, Linh P D, Diwan V K
Department of Social Medicine, Göteborg University, Vasa Hospital, S-411 33 Göteborg, Sweden.
Health Policy Plan. 2001 Mar;16(1):47-54. doi: 10.1093/heapol/16.1.47.
In Vietnam, as in many other countries, tuberculosis (TB) control has long been organized exclusively within the public health-care system. However, recently the private health-care sector has become more important and private health-care providers currently have a role in TB care delivery in Vietnam. Through a retrospective survey of patients at District Tuberculosis Units (DTUs) of the National Tuberculosis Programme in Ho Chi Minh City, we investigated utilization of private and public health-care providers among people with symptoms of TB. Eight hundred and one patients in eight DTUs were interviewed. For the current illness episode, about half of the patients had initially opted for a private health-care provider. Twenty-seven percent had been to a private physician and 31% to a private pharmacy at some time during their current illness. We found no significant association between socioeconomic status and use of private health-care providers. Utilization of private health-care providers among people with TB or symptoms of TB in Ho Chi Minh City seems to be similar to the general utilization of private providers in Vietnam, at least before TB is diagnosed. Since a large proportion of people with TB in Ho Chi Minh City across all economic and social strata consult private providers at some time during their illness, planners of TB control strategies need to consider both the health-care seeking behaviour of people with TB and the clinical behaviour of private providers, in order to secure early detection of TB, early initiation of appropriate treatment, and maintenance of appropriate treatment.
在越南，与许多其他国家一样，长期以来结核病防治工作完全在公共卫生保健系统内开展。然而，近年来，私营卫生保健部门变得更加重要，目前私营卫生保健提供者在越南的结核病护理服务中发挥着作用。通过对胡志明市国家结核病项目区结核病防治单位（DTUs）的患者进行回顾性调查，我们研究了有结核病症状的人群对私营和公共卫生保健提供者的利用情况。对8个DTUs的801名患者进行了访谈。对于当前患病情况，约一半患者最初选择了私营卫生保健提供者。在当前患病期间，27%的患者曾看过私人医生，31%的患者曾去过私人药店。我们发现社会经济地位与私营卫生保健提供者的使用之间没有显著关联。胡志明市结核病患者或有结核病症状的人群对私营卫生保健提供者的利用情况，似乎与越南私营提供者的总体利用情况相似，至少在结核病被诊断之前是这样。由于胡志明市所有经济和社会阶层的大部分结核病患者在患病期间的某个时候都会咨询私营提供者，结核病控制策略的规划者需要考虑结核病患者的就医行为以及私营提供者的临床行为，以便确保结核病的早期发现、适当治疗的早期启动以及适当治疗的持续进行。
