金钱成本和时间成本对巴布亚新几内亚农村地区发热儿童照料者选择医疗服务提供者的影响。

Effect of pecuniary costs and time costs on choice of healthcare providers among caregivers of febrile children in rural Papua New Guinea.

作者信息

Tsukahara Takahiro, Sugahara Takuma, Ogura Seiritsu, Hombhanje Francis Wanak

机构信息

Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.

School of Economics, Hosei University Graduate School, 2-15-2 Ichigaya Tamachi, Shinjuku-ku, Tokyo, 162-0843, Japan.

出版信息

Health Econ Rev. 2019 Dec 11;9(1):33. doi: 10.1186/s13561-019-0250-x.

DOI:10.1186/s13561-019-0250-x

PMID:31828554

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6907116/

Abstract

BACKGROUND

User fees, transportation costs, and time costs impair access to healthcare by rural communities in low and middle income countries. However, effects of time costs on demand for healthcare are less understood than effects of user fees for health providers. In addition, prospective patients might not know about all health services available. This study aims to investigate how the family caregivers of febrile children respond to the pecuniary costs and time costs in their choice of health providers in rural Papua New Guinea.

METHODS

Using an original questionnaire, we surveyed households in the catchment area surrounding Dagua Health Center in East Sepik Province, Papua New Guinea, during February-March 2015. We estimated the probability of choosing one among four categories of providers (i.e., the health center, aid posts, village health volunteers [VHVs], or home-treatment) via a mixed logit model in which we restrict alternatives to those for which family caregivers knew cost information.

RESULTS

Of 1173 family caregivers, 96% sought treatment for febrile children from four categories of providers. Almost all knew the location of the health center and a health volunteer, but only 50% knew the location of aid posts. Analysis by discrete choice model showed that pecuniary costs and time costs were inversely associated with the probability of choosing any type of provider. We then changed pecuniary costs and time costs counterfactually to calculate and compare the probability of choosing each provider. Time costs affected the choice more than pecuniary costs, and individual heterogeneity appeared among caregivers with respect to pecuniary costs. When pecuniary or time costs of VHVs are altered, substitution between VHVs and home-treatment appeared.

CONCLUSIONS

Our findings suggest that policies to increase awareness of aid posts and reduce time costs in addition to treatment fees for each category of healthcare provider could help developing economies to improve access to essential healthcare services.

摘要

背景

在低收入和中等收入国家，使用费、交通成本和时间成本阻碍了农村社区获得医疗保健服务。然而，相较于医疗服务提供者收取的使用费对医疗需求的影响，时间成本对医疗需求的影响鲜为人知。此外，潜在患者可能并不了解所有可用的医疗服务。本研究旨在调查巴布亚新几内亚农村地区发热儿童的家庭护理人员在选择医疗服务提供者时如何应对金钱成本和时间成本。

方法

我们于2015年2月至3月期间，使用一份原始问卷对巴布亚新几内亚东塞皮克省达瓜健康中心周边集水区的家庭进行了调查。我们通过混合逻辑模型估计了在四类医疗服务提供者（即健康中心、援助站、乡村健康志愿者[VHV]或家庭治疗）中选择其一的概率，在该模型中，我们将选择范围限制在家庭护理人员知晓成本信息的选项中。

结果

在1173名家庭护理人员中，96%的人从这四类医疗服务提供者中为发热儿童寻求治疗。几乎所有人都知道健康中心和一名健康志愿者的位置，但只有50%的人知道援助站的位置。离散选择模型分析表明，金钱成本和时间成本与选择任何类型医疗服务提供者的概率呈负相关。然后，我们通过反事实改变金钱成本和时间成本，以计算和比较选择每个医疗服务提供者的概率。时间成本对选择的影响大于金钱成本，并且在护理人员之间，金钱成本方面存在个体异质性。当改变VHV的金钱成本或时间成本时，VHV和家庭治疗之间出现了替代效应。