Household decision-making on child health care in developing countries: the case of Nepal
Household decision-making on child health care in developing countries: the case of Nepal
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DOI：
10.1093/heapol/czh027
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发表时间：
2004-07-01
影响因子：
3.2
通讯作者：
Sauerborn, R
中科院分区：
文献类型：
--
作者：
Pokhrel, S;Sauerborn, R
关于卫生保健利用的定量研究往往忽视了捕捉家庭决策过程“途径”的重要性。本文提供了一个四步结构，其中绘制了一个层次尺度的家庭决策有关儿童保健。该结构从对疾病的感知开始，接着是对护理和提供者的选择，最后以医疗保健支出结束。通过对1996年尼泊尔生活水平调查的全国代表性数据的描述性分析，该结构得到了证实。总人口中约有10%的人报告患病，其中69%的人寻求治疗，根据他们选择的提供者，他们在医疗保健方面的支出占其人均家庭年支出总额的2.5%至4.3%。双变量分析发现了对疾病感知的年龄和性别偏见，但如果一个孩子被报告生病，所有后续步骤都被发现没有这种差异。考虑到收入和母亲受教育程度影响的进一步分析表明，男孩和女孩的疾病认知背后可能存在概念上不同的家庭动态；这最终决定了是否寻求医疗保健。作者提出了一个假设，以供未来的研究验证。他们认为，性别角色显著影响对疾病的认知，但不一定影响随后的求医行为。讨论了这一假设与解释南亚儿童死亡率差异的典型特征的相关性。
Quantitative studies on health care utilization often overlook the importance of capturing the 'pathway' of household decision-making processes. This paper offers a four-step construct which maps out a hierarchical scale of household decision-making regarding child health care. The construct begins with the perception of illness, moves on to choice of care and provider, and finally ends with health care expenditure. The construct is substantiated by means of a descriptive analysis of nationally representative data from the 1996 round of the Nepal Living Standards Survey. About 10% of the total population reported illness, 69% of whom sought care, and depending upon the provider they chose, spent between 2.5 to 4.3% of their per capita household total annual expenditure on health care. Bivariate analysis detected age and gender biases in the perception of illness, but if a child was reported ill, all subsequent steps were found to be free from such differences. Further analysis, that took into account the changing effects of income and mother's education, indicated that there may be conceptually different household dynamics that underlie boys' and girls' illness perception; this ultimately determines whether or not health care is sought. The authors put forward a hypothesis to be tested by future studies. They argue that gender role significantly affects the perception of illness, but not necessarily the subsequent care-seeking. The relevance of this hypothesis to explaining the typical South Asian characteristic of differential child mortality rates is discussed.