Determinants Of Health Care Utilization Health And Social Care Essay

Determinants Of wellness dispense Utilization wellness And br new(pre nary(prenominal)inal)ly C atomic issuance 18 EssayAll pile around the world could non entranceway to wellness tutel progress table dish out as there is a operative unmet bring for wellness disturbance. In hostelry to improve the quality of gentleman life, the wellness cathexis showrs and policy makers should work a better fel low-pitched feeling of why people utilize or not utilize the wellness heraldic bearing go. In the changing of global environment such as population growth, increased wellness problems, high(prenominal)(prenominal) demand for medical c atomic come 18 and advanced medical technologies, wellness c atomic number 18 use of goods and run is increasing in every argonna around the world. As wellness fearfulness expenditure has been escalating, financing for wellness c ar is decent champion of the challenges for brasss especially in low and middle income countries.In many developing countries, the monetary origin for wellness c ar is dominated by close sector as house-hold out of pocket reconcilement. However wellness restitution policy evasions atomic number 18 becoming an increasingly recognized tool in recent decades to finance low and middle income countries. As one of the sufferingest countries in South-East Asia, Myanmar wellness finagle financing mainly relies on unavowed financing source in a form of out-of pocket payment. check to (NHA 2008-2009), 85% of total health expenditure comes from hidden household.In Myanmar, there are some financial evasions initiated by the g everyplacenment in site to protect the financial bewildered and impoverishment of the people. Among those health financing schemes, sociable g jump on plan (draft) plays a role to pool the risk of financial burden among insure workers. Myanmar government started the neighborly health indemnity in 1956 to post cordial assistances and health s afekeeping work to the see to it workers. Regardless of the want period of implementation, the report get on with of hearty health insurance is only 0.97% of total population and 1.96% of on the job(p) population. There are 93 clinics in 110 townships to provide health do work to insured workers ( social certificate Board 2012). The clinic time is from 800 am to 400pm which is during operative hours of insured workers ( cordial protective cover Board 2012). The social guarantor clinics locations are mostly not closed with the work places. The film director of affable Security Board (SSB) mentioned about health premeditation function in the news interview that, The current health direction constitution is not enough for workers as the social guarantor clinics later partnot provide 24-hour service. accessible security clinics cannot be found all over the hoidenish so workers in areas where there are no social security clinics can face difficulties.(The Myanmar Tim es, April 16-22, 2012). isolated from the difficulty in accessibility, the insured workers break to defend travel cost and time cost to access health operate from social security clinics. Moreover, there is very limited in equipments, musics and facilities to provide enough health function to the insured workers. So some insured workers dont visit to social security clinics and get the medical oversee from near clinics and treat with tralatitious medicines. maven of the SSB member expressed her experience from a boards clinic in Yangon as not be pleasant. She mentioned, There was a long queue of patients and I was particularly upset by the poor service from the doctors and nurses and I really dont trust them they dont surrender specialists, they have only habitual practitioners. I only went there to claim the cost of my medicines.(The Myanmar Times, April 16-22, 2012).Because of difficulties for workers to visit the clinics, health make do teams from clinics have been t rying to provide health take services in work places however the very limited number of vehicle and cost of patrol are the big challenging issue for the health care providers. Despite of monthly function from their fee, because of hardly to access health care facility from social security, the insured workers could not get their make from social security board.However, Myanmar has been opening a new chapter of reform after 2010 worldwide election and adopting democratic system in the verdant. As the country opening up, there are many reforms have been doing in order to move along with the ASEAN and global community. Myanmar SSS has been reformed to extend its reporting not only in formal but to a fault to slack sectors. A new Social Security Law has been enacted in 2012 and impart be implemented in 2013. Currently, the board has been preparing to introduce the new faithfulness for the insured workers.Along with the reform process, netherstanding the behaviors and factors affecting health care enjoyment is very important for the policy makers to improve the quality of services in order to attract the personal workers to cipher in the scheme. By oeuvreing determinant health care role among insured private workers, we could observe that who pay for and who get benefit from the scheme. Apart from this we could besides incur the most influencing factors which hinder and encour era the insured workers to utilize health care services from social security scheme.RESEARCH QUESTIONSGeneral research questionsWhat are the determinants of health care use of goods and services among insured private workers under Social Security Scheme in Hlaing Thayar Township, Yangon, Myanmar in 2012?Specific research questionsWhat are the barriers to access health care services for insured private workers under Social Security Scheme in Hlaing Thayar Township, Yangon, Myanmar in 2012?Research ObjectivesTo individualism the determinants of health care use of goods and services among insured private workers under Social Security Scheme in Hlaing Thayar Township, Yangon, Myanmar in 2012To make the barriers for insured private workers to access health services from Social Security Scheme in Hlaing Thaya Township, Yangon, Myanmar in 2012Scope of the subject fieldThis subject area ordain be cerebrate on insured private workers under the Social Security Scheme in Hlaing Thayar industrial zone, Hlaing Thayar Township, Yangon, Myanmar. The insured workers with the bestride of over 18 come on and currently employed by private owned factories and firms go forth be involve in this news report. The cross-sectional info forget be equanimous in February and present 2013.HypothesisThe get along with, gender, marital military position, number of children, ethnicity, godliness, educational status, occupation, income, exceed from work place to health facilities, perceived travelling cost, infirmaryity of the health care personnel, satisfaction to the services, number of health facilities another(prenominal) than social security health facilities in the area, perceived health status and presence of primal illness or disabilities influence the health care utilization among insured private workers under Social Security Scheme in Yangon, Myanmar.Myanmar health care systemMyanmar health care system is pluralistic with the cock of humans and private providers. As the countrys administrative system has been changed, the key providers in health care services also have changed. However, ministry of health is lock up the major provider of the health care services through and through ordinary health facilities go other ministries also provide some health care services (Ministry of health, 2012).Ministry of Health is taking responsible to implement holistic health care including preventive, curative and rehabilitative care to the people fit in to social objectives of the country laid down by National Health Committee. Ther e are 7 departments under Ministry of Health and Department of Health is one of the departments to provide comprehensive health care to all citizens. Apart from Ministry of Health, other ministries such as Ministry of Defense, Railway, Mine, Industry, Energy, Home and Transportation also provide health care to their employees. Ministry of Labor, booking and Social Security established Social Security Board with 3 general hospitals and 93 clinics across the country to take care of insured workers under Social Security Scheme. Myanmar pharmaceutic Factory which is under the Ministry of Industry supplies medicine and therapeutic agents for domestic market. One thing special for Myanmar health care system is that there is traditional medicine along allopathic or modern medicine. Apart from public health facilities, local NGO such as Myanmar Maternal and babe Welfare Association and Myanmar Red Cross Society and international donors are also provide some fragments of health services t o fill up the gap in the community (Ministry of Health 2012).Financing of health care services are from cardinal main sources government as general taxation, private household contribution as out-of pocket payment, social security system and community contribution. External donation in form of assistances is also play a role in Myanmar health care financing. biotic community Cost Sharing Scheme union Cost Sharing (CCS) scheme is established in 1992. It is simply a user fees system with the role to charge curative cost for health care services from the abundant and provide exemption to those who could not effort for their health care expenditure. According to SSC scheme, the cost for laboratory, radio imaging, private room, drug and medical equipments are asked to pay for those who can effort. The revenue from CCS scheme is broken down into three portions 1) 50 percent is for government revenue, 2) 15 percent go for purchasing medicine and medical equipments and 3) the last 15 p ercent use for maintenance. However, there are no clear criteria for the poor to provide exemption and many challenges are coming up in the implementation level.(Aye et al.)Revolving dose FundRevolving Drug Fund was introduced in 1990 by Myanmar Essential Drug Program. The program started in 9 townships as pilot project and whence extended into carbon townships in 1995. The stemma is started by WHO, UNICEF, Sasakawa Foundation and the pedigree is used as a seed grant.(Aye et al.)Trust FundTrust Fund is another(prenominal) finance source for health care and the objective is to finance to poor patient who cannot pay the cost of health care at public hospitals. The policy for Trust Fund is ONE BED ONE hundred thousand and it is raised 100,000 Kyat per bed to hospital by the donation from community. Trust fund are normally kept as saving count at bank and the annual interest from that is utilized according to trust fund management committee or hospital management committee(Aye et a l.).Social Security SchemeSocial Security Scheme (SSS) is the solely health insurance scheme in Myanmar. It was introduced in 1956 according to 1954 Social Security Act. The SSS is implemented by SSB under the Ministry of Labor which has recently transformed into Ministry of Labor, Employment and Social Security. The objectives of SSB are to improve the health of the insured workers, to enhance their working ability and to boost productivity, to provide effective benefit in measure of social contingencies such as sickness, maternity and employment injury, unemployment, old-age, and death etc, to take for the insured workers and family members for living when the formers are unable to work and to make the social security scheme concern the entire population. In order to strive these objectives, social security board is carrying its duty and functions by ensuring workers enjoy rights and tribute gr backd under the various labor laws, providing social services for the workers, prom oting high productivity of labors and participating in international labor affair ( Social Security Board, 2012).The premium for Social Security Scheme is mandatory contribution from employee and employer. The contribution is based on tripartite contribution by 2.5 % of the workers salary from employer, 1.5% from the employee and government supports the capital investments as necessary. The contribution is collected according to 15 wage classes. The coverage groups are state enterprise employees, temporary and immutable employees of public or private firms with five or much(prenominal)(prenominal) employees in certain establishments such as railways, ports, mines and oilfields. The employment with less than five employees, structure workers, agricultural workers and fishermen are excluded from the coverage of social security scheme (Social Security Board, 2012).At first, it is started from the cities and then extended into other towns gradually. One 250 bedded workers hospital in Yangon, one 150 bedded hospital in Mandalay and one 100 bedded TB hospital and 93 clinics have be run under the Social Security Board in order to provide health care services to insured workers.(Social Security Board, 2012).In benefit package, it is divided into cash sickness benefit, agnatic benefit, and medical benefit. For cash sickness benefit, 50% of the insured workers come earning willing be include from the first day of illness up to 26 weeks for one illness. realise of temporary and permanent hindrance and survival benefits are also included in cash benefit. As funeral grant, 40,000 (Kyat) is paid to the deceaseds surviving spouse and child. The maternal cash benefit includes 66% of insured workers average earning for 12 weeks (6 weeks forrader and 6 weeks after delivery). For medical benefit, free medical services are directly provided by Social Security Boards clinics. Medical services include the medical care at the clinic, emergency shell care, specialist an d laboratory services at diagnostic center, necessary hospitalization, maternity care and medicine(Social Security Program Throughout the World Asia and the Pacific 2010, 2011).Literature followThe lit review for this study will be broken down into experiential studies on health care utilization and determinants of health care utilization.Health Care UtilizationA study in Canada(Curtis MacMinn, 2008) about health care utilization in twenty-five years of evidence to identify the relationship between the socio- economic status and utilization, controlling and demographic characteristics. The study describes figure of speech of health care utilization under public health insurance scheme. They investigated about physician, specialist and hospital care utilization between 1978 and 2003. The data from Canada Health Survey (1978), General Social Survey (1991), and Canadian Community Health Survey (2001 and 2003) were extracted to analyze the different in utilization over 25 years pe riod. It shows that health care utilization is growing through time. The populations with lower level socio-economic status (income, education, or employment) have on average less likelihood of visiting physician than those with middle socio-economic status. Individuals with lower levels socio-economic status have lower utilization of specialist care than those with higher economic status. For hospitalization, poorer individuals have slightly longer stay than with middle and higher income groups. The results also shows that health care utilization of publicly insured individual have strongly related with the health status of them.A Vietnamese scholar(Nguyen, 2012) canvass the impact voluntary health insurance on health care utilization in Vietnam by using a descriptive and manakin study with secondary data. He looked at the trend of voluntary health insurance members, categories, revenues and expenditures and health care utilization in the whole country for 5 years period (1993-19 97). The study shows that the trend of health care utilization is increasing during 5 year period but the number of hospital visit of voluntary health insurance members is lower than those give by out-of pocket payment. The results of the study only can predict the utilization rate based on the macro factors and could not include other factors that could affect health care utilization among insured individuals.Health insurance does effect the health care utilization and it is revealed in a study from Burkina Faso by (Gnawali et al., 2009). They investigated the impact of community-based health insurance on health care utilization in rural Burkina Fuso. The results show that the individuals who insured under community-based health insurance scheme utilized out- patient services 40% more than than those who are not insured however in-patient utilization rate is not significantly changed. Moreover, the study explains that low income groups are less likely to enroll in the scheme and even though they are once insured, health care services utilization is still lower than middle and higher income groups. Health insurance has a statistically significant effect on utilization of health care.In Sri Lanka, (Priyanjith H. 2008) studied the factors affecting health care utilization with three common complaints Bronchial Asthma, Ischemic Heart Disease, viral Fever. He has conducted cross-sectional descriptive survey and the respondents were selected randomly. The results demonstrate that patients age, health care expenditure and household monthly income, number of dependents in the family and religion have significant relationship with utilization of health care facilities. Age, family income level, perception and religion (Buddhist and Sinhala) have positive influence on health service utilization while health care expenditure, outperform to access health facilities, number of family members and dependents in the family negatively correlated with health care utilizati on.Determinants of health care utilizationSocio-demographic FactorsAgeA study in Ethiopia by (Girma, Jira, Girma, 2011) shows that children the age under five-year old used health facilities 3.5 generation than those above the age of 65. A study in Nigeria by (Aigbe Osariemen, 2011) concluded that maternal age is the main predisposing factor to utilize antenatal care service. The women with age of 15-19, 40-44 and 45 years old utilized unpredictable source (traditional birth attendants, home assistance and church) 63.6 %, 65% and 55.6% respectively and the middle age pregnant women with the age of 20-39 used unconventional source between 30 to 40.5%. The middle age pregnant women have significantly lower rate of using unOrthodox sources for antenatal care. The individuals older than 24 years old were significantly more likely to utilize health care services than younger age (Hu Podhisita, 2008). A study in New Mexico counties, USA by (Anderson, 1973) shows that age has negativ e effect on hospital admission rate.GenderIn Nepal, when holding other shiftings constant, boys have 43% more likelihood to try on external health care given illness than girls (Pokhrel et al., 2005). Men were 0.46 measure tendency to utilize health care services than women(Girma, Jira, Girma, 2011). In Myanmar culture, women are usually given equal chance and not regarded as socially inferior. There is strong relationship between gender and using health care facilities and women visited health services more than men among Myanmar migrant workers in Ranong, Thailand (Aung, 2008).Marital StatusIn Ethiopia, married individual were 8.1 times more likely to visit health facilities than those unmarried one. (Girma, Jira, Girma, 2011).EthnicityA study by (Anderson, 1973) conclude that ethnicity is one of predisposing factors for health care utilization. Hospital bed-population ratios are higher in the counties with larger ethnic minority group. However (Hu Podhisita, 2008) reveals t hat if the ethnic groups have the same opportunities(predisposing, enabling factors), health care utilization will be likely similar.Educational statusIn Nigeria, the choice of antenatal care sources between orthodox and u northeastodox is associated with the education of mother. They pointed out that the usage of unorthodox sources of antenatal care is 83% among with primary education level. The choice for orthodox source is 53% among the mother with secondary education and which is tripled with those of primary education(Aigbe Osariemen, 2011). In Curacao, Netherland, educational level is strongly related with utilization of dentist and physiotherapist. The results indicates that people with the highest educational level in the study utilized dental service a year almost five times than those with the lowest educational level(Alberts, J, Eimers, Den, 1997).IncomeAnnual household income is associated with the level of utilization of health care services. belittled income group w as 0.26 times likely to use health care facilities (Girma, Jira, Girma, 2011)availableness to Health Care Services outdo to the health facilitiesA study by (Nemet Bailey, 2000) shows the relationship between duration and utilization that as the distance increase, health care utilization is reduced. Another study in Nigeria by (Aigbe Osariemen, 2011) concludes that distance to health facility from their sign of the zodiac is important factors for women to seek ante natal care. They found out that majority of women (76%) utilized the nigh health center which takes less than 30 minute with vehicular transportation from their residence while only 5.9% of women travelled to access health care services from facilities that need more than 45 minute to arrived. In Ethiopia, distance to the closest health facilities is one of important factors on utilization of health facilities, the study concluded that the individuals who live in 10 kilometers or less to the nearby institution were 1.5 time more likely to use health facilities. delay time at health facilitiesAlmost two-third (62.8%) of pregnant women who visited primary health care or private hospitals for antenatal care is for the reason of promptitude of the services (Aigbe Osariemen, 2011). perceive travelling costIn comparison, among the individuals who perceived travelling cost as cheap ,the health services utilization were 2.5 times likely to be higher than those perceived it as expensive. imply FactorsPerceived health statusA study in Ethiopia by (Girma et al., 2011) revealed health care utilization was associated with individuals perceived health status. They mentioned that in compared to individuals with good health status, those with poor and very poor health status, utilized 11.7 and 13.1 times more respectively. A study by (Fernandez-Olano et al., 2006) shows that perceived health status alter the health care utilization pattern among elderly people. It can be concluded that 36% of elderly users and 60.2% of non-users graded their health status as good and they reported their health status as fair 46% and 29% respectively. presence of underlying disease or disabilityThe individuals with disability are 3.3 times likely to use health care services and those who had health problems utilized health care 28 times(Girma et al., 2011). (Liu, Tian, Yao, 2012) studied the cause of health profile on health care services utilization in Taiwan. Health profiles were divided into 4 groups Relatively Healthy, High Co morbidity, Frail Group and Functional Impairment and they found that, High Co morbidity group had more likely to utilize health care services heavily than Frail Group and Functional Impairment while Relatively Healthy regarded as a reference group.A study in Philippine shows that the need factors have strongly associated with the hospital stay. The patients with intensifier cases stayed at hospital longer than ordinary cases(Loquias, Kittisopee, Sakulbamrungsil, 2006)Summ aryThe literature review shows some uncertains influence the health care utilization of individuals. This study will be included the multivariates that could possibly affect health care utilization decision of insured workers under Social Security Scheme.RESEARCHMethodologyConceptual exemplarThe conceptual framework for this study is based on the Andersons Behavior mold for health care utilization. Many studies on health care utilization have been done based on Adersen Behavior Model. The model composes of three main factors predisposing, enabling and need factors. Predisposing factors are the individuals tendency to utilize health care which include demographic characteristics (age, sex, marital status) and social structure (occupation, education, ethnicity, religion). enabling factors refers to the ability of an individual to make use health services they include the family and community resources that can affect health care utilization. Need factors is the individuals need f or health care by re designateing perceived health status and present of chronic disease and disability.Predisposing Factors(Socio-demographic)AgeGenderMarital statusEthnicity worshipEducation statusOccupationEnabling FactorsCommunity ResourcesDistance to health facilitiesWaiting Time at the clinicPerceived Travelling cost cordial reception of health care personalSatisfaction to the serviceNo. of other hospitals/ clinics near workplaceFamily ResourcesIncomeNo. of children (family size)Health Care UtilizationGo to social security health facilitiesGo to private health facilitiesGo to public health facilitiesBuy drug from drug storeNeed FactorsPerceived health statusPresent underlying disease or disabilitiesStudy DesignCross- sectional descriptive quantitative design will be used for this study in order to explore health care utilization pattern among insured private workers under Social Security Scheme in tow industrial zones ( Hlaing Thaya and South Dagon) in Yangon, Myanamr.Study Ar eaYangon is the largest city and formal capital of Myanmar with population nearly 6 million in 2008. The population growth rate of Yangon piece is 2.2 percent per annum in 2008 which is higher than national growth rate. The population compactness is 666 per square kilometer in 2008. As Yangon is logical site for export- orientated lighted manufacturing, it attracts the people from rural to immigrate and settle in the city. Yangon is laid on a peninsula near the confluence of the Yangon and Bago rivers, about thirty kilometers north of the Gulf of Martaban. The city has been extended recently to the east, west, and north both for residential and industrial zones. In Yangon Division, there are 45 administrative townships and 33 of them are in Yangon city municipal and administered by Yangon City discipline Committee (YCDC).The study will conducted in Hlaing Tharyar Townships in Yangon city municipal area.Study DurationThe study will be conduct from February to March 2013.Study p opulationThe study will be conducted among the insured private workers under the Social Security Scheme in two industrial zones Hlaing Thaya Township Yanagon, MyanmarSample sizeThe sample size for this study will be calculated based on Yamane (1967 98-99) formula.n= Nz 2 pq/Nd 2 +z2pqIf we assume z =2 (1.96 for the 95% level of reliability), thenn = N/ 1+Nd2n = sample sizeN= population sized = precision (0.05)z = reliability coefficientp = proportion of the target population utilize health care (assuming that 50%)q =1-p (so q= 50% too)The population of insured workers in Yangon division is approximate 350,000. I calculated my sample size based on the total no. of population and I got 399.49 and 10% is added for non responded participants. So the sample size is 439.49 (340). take techniquesThe multi-stage sampling method will be employed in this study. Hlaing Thayar industrial zone is purposively selected and the participants will be randomly selected from total study population.Incl uding CriteriaThe workers from private sectorsThe workers who are insured under Social Security Scheme (SSS)The workers who are working in Hlaing Tharyar Industrial Zone, YangonThe workers who are over 18 years oldExcluding CriteriaThe workers who are not employed by private factors or firmsThe workers who are not insured under social security schemeThe insured private workers who are not willing to participate in the interviewStudy inconsistentsDependent VariableThe dependent variable will be multinomial variables. Health care utilization will be categorized into 4 categories 1) go to social security health facilities 2) go to private health facilities 3) go to public health facilities 4) buy drug from drug store.Independent VariablesThe independent variables are age, gender, marital status, ethnicity, religion, educational status, occupation, family size, distance from work place to health center, waiting time, perceived travelling cost, hospitality of health care personnel, perc eived health status, presence of underlying disease or disabilitySummarized table of independent variablesVariablesAbbreviationExpected bell ringer11Age ( continuous variables)age+/-22Gender (dummy variable male=1, female=0)gen+/-33Marital status (category dummy variablems+44No. of children (continuous variables)child55Ethnicity ( dummy variable Burma=1, other ethnicity=0)eth+/-66Religion(dummy variable Buddhist=1, Other religion=0)rg+/-77Educational status( category dummy variable primary=0, secondary=1, higher =1)edu+88Occupation (category dummy variable.occ+/-99Income( continue variable)inc+110Distance from work place to health facilities (continue variable)dis111Waiting time at health facilities(continue variable)wt112Perceived travelling cost (dummy variable expensive=1, cheap=0)ptc113 cordial reception of health care personnel (dummy variable yes=1, No=0)hhp+114Satisfaction to the services (dummy variable yes=1, No=0)sts+115No. of health facilities other than social securitys health facilities ( continue variable)nhnw+116Perceived health status (category dummy variable excellent=1, good=1, fair=0, poor=1, very poor=0)phs+117Presence of underlying disease (dummy variable yes=1, No=0)pud+Multinomial logistic Regression ModelLog(Pr(Y=yi)/Pr(y=0))=0+1age+2gen+3ms+4eth+5rg+6edu+7occ+8 ln(inc)+ 9dis+ 10wt+ 11ptc+ 12hhp+ 13sts+14nhnw+15phs+16pud +iPilot testThe pilot test will be conducted in one of the townships in Yangon with the similar characteristic of insured workers before actual survey. The questionnaire will be revised and adjusted based on the results from pilot testing.Data gathering toolsThe primary data will be collected suing the structured questionnaires. most 5 interviewers will be hir