LSE Health, London School of Economics, Houghton Street, London WC2A 2AE, UK.
Soc Sci Med. 2012 Oct;75(8):1450-9. doi: 10.1016/j.socscimed.2012.05.032. Epub 2012 Jul 4.
Although socioeconomic status is acknowledged to be an important determinant of modern health care utilisation, most analyses to date have failed to include traditional systems as alternative, or joint, providers of care. In developing countries, where pluralistic care systems are common, individuals are likely to be using multiple sources of health care, and the order in which systems are chosen is likely to vary according to income. This paper uses self-collected data from households in Ghana and econometric techniques (biprobit modelling and ordered logit) to show that rising income is associated with modern care use whilst decreasing income is associated with traditional care use. When utilisation is analysed in order, results show rising income to have a positive effect on choice of modern care as a first provider, whilst choosing it second, third or never is associated with decreasing income. The effects of income on utilisation patterns of traditional care are stronger: as income rises, utilisation of traditional care as a first choice decreases. Policy should incorporate traditional care into the general utilisation framework and recognise that strategies which increase income may encourage wider utilisation of modern over traditional care, whilst high levels of poverty will see continued use of traditional care.
尽管社会经济地位被认为是现代医疗保健利用的重要决定因素，但迄今为止，大多数分析都未能将传统系统作为替代或联合的医疗保健提供者纳入其中。在多元医疗保健系统普遍存在的发展中国家，个人可能会使用多种医疗保健来源，而且选择系统的顺序可能会根据收入而有所不同。本文利用加纳家庭自行收集的数据和计量经济学技术（双变量概率模型和有序逻辑），表明收入增加与现代医疗保健的使用相关，而收入减少与传统医疗保健的使用相关。按顺序分析利用情况时，结果表明，收入增加对选择现代医疗保健作为首选提供者有积极影响，而选择其作为第二、第三或从未选择的提供者与收入减少相关。收入对传统医疗保健利用模式的影响更大：随着收入的增加，将传统医疗保健作为首选的利用率会降低。政策应将传统医疗保健纳入一般利用框架，并认识到增加收入的策略可能会鼓励更多地利用现代医疗保健而非传统医疗保健，而贫困水平较高则会继续使用传统医疗保健。
