NATIONAL UNIVERSITY OF HCM INSTITUTE OF SOCIAL STUDIES UNIVERSITY OF ECONOMICS THE HAGUE VIETNAM THE NETHERLANDS VIETNAM-THE NETHERLANDS PROJECT ON DEVELOPMENT ECONOMICS EFFECT OF EDUCATIONAL LEVEL ON SELF-MEDICATION DECISION OF PATIENTS IN HOCHIMINH CITY A thesis submitted in partial fulfillment of the requirements for the degree of MASTER OF ARTS IN DEVELOPMENT ECONOMICS By BO.GIAo ovc ~At: :. PHAM QUANG ANH THU TRUdNG fJH KINH .HCM TI:!_li VIiJ~'N 5 6~Zr; Academic Supervisor: DR. NGUYEN VAN NGAI HO CHI MINH CITY, AUGUST 2007 LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com ACKNOWLEDGEMENTS The author would like to express sincere thanks and special thanks to the academic supervisor Dr. Nguyen Van Ngai for his assistance and suggestion during the writing of this thesis.
I am grateful to Dr. Nguyen Trong Hoai, Dr. Nguyen Hoang Bao and Dr. Arjun Singh Beddi for their useful comments on thesis proposal and thesis drafts which are helpful to the author in doing the thesis.
I also express my special thanks to M.A Truong Dang Thuy, without his regular and precious advices the author could not complete the research. Great appreciation is expressed to my classmates, Quyen and Vy, for their honest friendship, enthusiastic support and sharing during studying at the Vietnam - Netherlands Program for M.A in Development Economics. Sincere thanks go to my family for their spiritual encouragement and material support which helped me overcome all difficulties during pursuing my M. Last but not least, many thanks are given to the households who allowed the author to interview them.
LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com 11 CERTIFICATION I certify that the substance of this thesis has not already been submitted for any degree and is not being current submitted for any other degree. I certify that to the best of my knowledge any help received in preparing this thesis, and all sources used, have been acknowledged in this thesis. PHAM QUANG ANH THU Date: 01 August, 2007 LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com 111 ABSTRACT Self-medication is a common practice in many developing countries. In Vietnam, self-medication has grown in recent years due to the increasing availability of drug vendors and pharmacy shops throughout the country.
Beside the convenience, time and cost saving, self-medication is associated with risks such as misdiagnosis, use of irrational drug dosage that lead to the harmful consequences not only for patient himself but also for community as a whole. Investigating the determinants of self- medication practice of individuals facing illness is helpful for the health policy makers who are interested in improving the appropriate access of self-medication in public. This study focuses on examining the impact of educational level on self-medication practice in Ho Chi Minh city, the national center of educational and health care of the country. The descriptive statistics and econometric analyzes have been applied to answer the question whether the adult individuals with a higher education are more likely to be self-medicated.
The thesis has been employed the theory of consumer choice as the foundation theory, the Andersen's behaviour model, and two empirical studies to construct a health-seeking model which describes the way individuals make choices regarding health care utilization to get the highest level of utility. The findings based on the survey conducted by the author in Ho Chi Minh city show that the more educated individual is, the more self-medication he or she has in treating minor illness. LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com iv TABLE OF CONTENTS CHAPTER 1: INTRODUCTION. RESEARCH OBJECTIVE, RESEARCH QUESTION & RESEARCH HYPOTHESIS.
THE ORGANIZATION OF THE THESIS. 5 CHAPTER 2: LITERATURE REVIEW .2 Professional health care provider .3 Types of illnesses. Theory of consumer behaviour and the demand for health care services. Grossman's theory ofhuman capital and the demand for health care.
Andersen's behaviour model and access to medical care. Chang and Trivedi (2003) .2 Transforming theoretical framework into variables. 32 CHAPTER 3: VIETNAMESE HEALTH CARE AND DRUG UTILAZATION. HEALTH CARE UTILIZATION IN VIETNAM .1 Trends in health care seeking behaviour ofindividuals.2 The Cost of Health Services .3 Self-medication and reasons.
DRUG UTILAZATION & SOURCE OF DRUGS FOR SELF-MEDICATION IN VIETNAM. 44 CHAPTER 4: SELF-MEDICATION BEHAVIOUR OF PATIENTS IN HO CHI MINH CITY. OVERVIEW OF HO CHI MINH CITY- THE NATIONAL CENTER OF EDUCATION & HEALTH CARE .2 Price and attributes ofhealth care providers .3 Knowledge of drug safety ofrespondents. ECONOMETRIC ANAL YSES .1 Methods of interpretation.
2 Explanations ofregression results. 62 CHAPTER 5: CONCLUSIONS AND RECOMMEND ATIONS. 87 LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com v LIST OF FIGURES FIGURE 2.1: Available health consumption bundleJfor individuals with different health status •••.2: Effect of income on provider choice .3: Effect ofprice on provider choice ••.4: Andersen's Behavioural Model •.1: Selected reason for self-medication by age group •.••• 38 LIST OF TABLES TABLE 2.1: List ofvariables and expected signs •.1: Annualized health services contact rates, by provider •••••••••.2: Distribution oftotal health services contacts across providers in 1998 ••••••••.2: Demographic Information of Respondents by behaviour group ••••••.3: Changing in choosing health care providers ofGroup 3 ••••••••.4: Total cost oftreatment by behaviour group•.5: Total consuming time of treatment by behaviour group ••••••.6: Knowledge of drug safety by behaviour group •••••. 7: Knowledge of drug safety by behaviour and educational group •.•••••• 59 LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com vi ACRONYMS GSO General Statistics Office UN United Nations UNDP United Nations Development Programme VHI Vietnam Health Insurance VHSR Vietnamese Health Sector Review VLSS Vietnam Living Standards Survey VNHS Vietnam National Health Survey VNDP Vietnamese National Drug Policy WB World Bank WHO World Health Organization LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com vii CHAPTER 1: INTRODUCTION 1.1 PROBLEM STATEMENT After the economic reforms initiated in 1986 in Vietnam, the role of public health sector began to deteriorate which accompanied the emergence of private sector and the expanding of pharmaceutical industry.
Between 1986 and 1994 there was a three-fold increase in drug production and a six-fold increase in per capita drug consumption (Witter, 1996). The rapidly expanding drug vendors and pharmacy shops throughout the country have emerged now acting as an important health care provider. Data from Vietnam Living Standard Survey 1997-1998 (VLSS, 1997-1998) indicates that the contact rate with the health care system was dominated by the use of pharmaceuticals. According to the VLSS 2001-2002, self-medication is very common practice to deal with illness among Vietnamese households - 73 percent of patients reporting use of self-medication to deal with illness and most people procure medication for self-medication at pharmacists.
The common practice of self-medication has both positive and negative aspects. In cases of common illness, such as coughs or colds, self-medication may be rational behaviour in terms of convenient, time saving and cheap if patients have sufficient knowledge about common non-prescription drugs. But in cases of more serious disease, requiring the use of antibiotics or steroids, or in cases of special status such as pregnancy, babies, people with LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com 1 drug allergies, the treatment without consultation of medical professionals can lead to harmful consequences. In the latter cases, self-medication accompanied the lack of ability or awareness of the need to read the drug information lead to a risky of wasting money, status of sickness may be more serious.
The negative sides of self-medication not only affect the individuals but also the community. The large scale drug resistance in the community of Vietnam has increased and reached epidemic levels (Sam, 1993). The future potency of drug for all users is reduced, which has lead to increasing the amount of treatment failures, and as the result, leading to longer and more severe illness and demand for more expensive drugs. This result has increased financial burden on the poor and those without any medical knowledge a further reduction in equity (WHO, 2001a).
The promotion of the rational drugs use to minimize the negatives effects on the public health when the self-medication practice is prevalence in Vietnam is the emerging concern of health policy makers. Designing effective interventions can not be done without understanding factors impact on self- medication behaviour of people. In this study we focus on finding out the influence of educational level on self-medication behaviour of patients in Ho Chi Minh city, one of the biggest city of the country. LUAN VAN CHAT LUONG download : add luanvanchat@agmail.2 RESEARCH OBJECTIVE, RESEARCH QUESTION AND RESEARCH HYPOTHESIS Research objective On the demand side, the knowledge, attitudes, and education of an individual are important determinants in the decision to seeking health care.
The most important purpose of this study is to examining the impacts of educational level of the adults on their self-medication when being illness. The influences of other sociodemographic factors, attributes of health care provider on self-medication behaviour of patients in Ho Chi Minh city are also included in order to support the health policy makers who are interested in improving the appropriate access of self-medication in public. Research Question and Research Hypothesis It's realised that education level enhances the ability of accessing and criticising information of people. Therefore, an individual with high educational level is expected that might have high self-confidence about his medical knowledge which results in having more self-medication than lower educational person.
Hence, this dissertation attempts to answer the question: - Are adult individuals with higher years of schooling more likely to be self-medicated facing typical diseases? And the research hypothesis is: LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com 3 There is positive relationship between the level of education and the self-medication practices.3 RESEARCH METHODOLOGY The research question will be answered by descriptive statistics and econometric model. The descriptive statistics analyzes the relationships between independent and dependent variables, the knowledge and attitude toward self-medication of patients via numerical summaries and graphs. The influence of factors on self-medication behaviour will be analyzed via econometric model. This study observes the behaviour of those who had at least one times of using health care providers in the last three months, visiting doctor or visiting pharmacy, when being illness.
In a period of sickness, a patient might have one or several times of using medical services. Therefore, unit of analysis in this study is not the individuals but their number of visits to medical services when being illness. A cross sectional data for the analysis comes form the household survey data conducted by author in Ho Chi Minh city through structured interviews. This primary data has 120 patients with 227 contacts with health care providers.
Hence, we have 227 observations to regress empirical model by Stata tm 8. LUAN VAN CHAT LUONG download : add luanvanchat@agmail.4 THE ORGANIZATION OF THE THESIS Chapter 1: presents the introduction including problem statement, research question, research hypothesis and research methodology and data source, and the unit of analysis. Chapter 2 provides definitions of self-medication, professional health care provider and types of illness which is focus in this study. Theoretical framework is also discussed together with empirical researches.
The last section of this chapter is the model specification includes a justification of the empirical model, transforming concepts into variables. Chapter 3 introduces a general view about VietNam health care and drug utilisation. This chapter focused on providing the information about self- medication practice in VietNam based on the reports of VLSS 1997-1998 and VNHS, 2001-2002. Chapter 4 introduces sampling method with sample size and interview technique.
The descriptive method will be used to describe characteristics, knowledge, and attitude toward of self-medication of respondents in Ho Chi Minh city. Econometrics methods will be used to analyse influences of factors to self-medication of participants. Chapter 5 contains the conclusions and some policy implications. LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com 5 CHAPTER 2: LITERATURE REVIEW There are three sections in this chapter.
The definitions of key concepts relating to the research topic are introduced in the first one.