Department of Management Information Systems, University of Dhaka, Dhaka, Bangladesh
Department of Health Policy, The London School of Economics and Political Science (LSE), London, UK.
BMJ Open. 2021 Dec 6;11(12):e051434. doi: 10.1136/bmjopen-2021-051434.
The number of modern healthcare providers in Bangladesh has increased and they are well equipped with modern medical instruments and infrastructures. Despite this development, patients seeking treatment from alternative healthcare providers are ongoing. Hence, this study aims to determine the underlying predictors of patients' choosing modern healthcare providers and health facilities for getting treatments.
Data from the nationally representative Household Income and Expenditure Survey 2016-2017 conducted by the Bangladesh Bureau of Statistics were used.
34 512 respondents sought treatment for their illnesses from different types of available healthcare providers.
Patients' choice of healthcare providers (primary) and predictors of patients' choice of modern healthcare providers (secondary).
The study found that 40% of the patients visit modern healthcare providers primarily on having symptoms of illness, and the remainder goes to alternative healthcare providers. Patients living in urban areas (adjusted OR (AOR)=1.11, 95% CI 1.05 to 1.17, p<0.01), and if the travel time was between 1 and 2 hours (AOR=1.11, 95% CI 1.00 to 1.22, p<0.05) compared with travel time less than 1 hour, were positively associated to utilisation of modern healthcare facilities for their first consultation. The statistical models show that the predisposing and need factors do not significantly impact patients' choice of modern healthcare providers.
The distribution of modern healthcare providers should be even across the country to eliminate the rural-urban divide in modern healthcare utilisation. Enhancing the digital provision of modern healthcare services could reduce travel time, omit transportation costs and save waiting time for treatment by the modern healthcare providers. Policymakers can think of introducing a national health insurance programme in Bangladesh as a potential policy instrument.
孟加拉国现代医疗服务提供者的数量有所增加，他们拥有现代化的医疗仪器和基础设施。尽管有了这一发展，寻求替代医疗服务提供者治疗的患者仍在继续。因此，本研究旨在确定患者选择现代医疗服务提供者和医疗机构进行治疗的潜在预测因素。
本研究数据来自孟加拉国统计局开展的 2016-2017 年全国代表性家庭收入和支出调查。
34512 名受访者因疾病向不同类型的现有医疗服务提供者寻求治疗。
患者对医疗服务提供者的选择（主要）和患者选择现代医疗服务提供者的预测因素（次要）。
研究发现，40%的患者因出现疾病症状而首先选择现代医疗服务提供者，其余患者则选择替代医疗服务提供者。与 1 小时以内的旅行时间相比，居住在城市地区的患者（调整后的比值比（AOR）=1.11，95%置信区间（CI）为 1.05 至 1.17，p<0.01）和旅行时间在 1 至 2 小时之间（AOR=1.11，95% CI 1.00 至 1.22，p<0.05）更有可能首先选择现代医疗设施进行就诊。统计模型显示，倾向因素和需求因素对患者选择现代医疗服务提供者没有显著影响。
应在全国范围内均衡分布现代医疗服务提供者，以消除现代医疗利用方面的城乡差距。加强现代医疗服务的数字化提供，可以减少旅行时间、免除交通费用，并缩短现代医疗服务提供者的治疗等待时间。决策者可以考虑在孟加拉国引入国家健康保险计划作为潜在的政策工具。
