Health Seeking Behavior Post District Health System Reform in Cambodia

柬埔寨的地区卫生体制改革始于1996年。改革的主要特点是建立卫生管理操作区，并引入使用费。本研究的目的是描述地区卫生体制改革后的就医行为，并比较贫困人口和较富裕人口之间的就医行为。研究对象为育龄家庭主妇(15~49岁)。12%(350)的家庭是通过分层随机抽样的方式抽取的。数据收集采用家庭问卷调查和焦点小组讨论(FGD)。对257名符合选择标准的家庭主妇进行了分析。为了识别穷人，使用了住房单位建筑面积和资产所有权评级标准。对257名家庭主妇的1547名家庭成员进行了8次家庭卫生服务选择的影响因素调查。其中，677人在调查前30天内有过一次疾病发作。其中，649人采取了寻求健康的行动。在第一次行动中，71%的人尝试了家庭治疗，50%的人尝试了自我治疗。公共卫生设施利用率不到10%。排除那些在第一次行动中治愈的人和那些在调查时继续第一次行动的人，332人需要采取第二次行动。在他们中，297人实际上采取了第二种行动。37%的人使用私人服务提供商，33%的人使用自我药物治疗，13%的人使用Prek Dach健康中心。对比穷人和富人，穷人使用医疗中心的比例明显高于富人。感知的疾病严重程度和距离健康中心的距离也与健康中心的利用率有关。贫困人口健康中心的优势仅限于距离健康中心2公里以内。

District Health System Reform in Cambodia started in 1996. The main features of the reform were to establish Operational Districts for health administration, and introduction of user fees. The objectives of this research were to describe health seeking behavior post district health system reform and compare it between the poor and the better off.The study was conducted in Prek Dach Health Center coverage area in the Leuk Dek District, Kandal Province. Subjects were housewives of reproductive age (15 to 49 years old). Twelve percent (350) of the households were selected by stratified random sampling. Data were collected by household survey using structured questionnaire and focus group discussion (FGD). 257 housewives who met selection criteria were analyzed. To identify the poor, housing unit floor area and a rating scale on asset ownership were used. Eight FGD were conducted to investigate factors influencing on choice of health services.257 housewives had a total of 1547 family members. Of them, 677 had an episode of illness within the 30 days prior to the survey. Of them, 649 took health seeking actions. In the first action, 71% tried a home remedy, and 50% did self-medication. Utilization of public health facilities was less than 10%. Excluding those who were cured in the first action and those who were continuing the first action at the time of the survey, 332 needed to take the second action. Of them, 297 actually took the second action. 37% used private service providers, 33% did self-medication, and 13% used the Prek Dach Health Center.Comparing between the poor and the better off, the poor utilized the health center significantly more than the better off. Perceived severity of illness and distance from the health center are also related to the utilization of the health center. The advantage of the health center for the poor is limited within 2km of the distance from the health center.