INTRODUCTION
RESEARCH OBJECTIVE, RESEARCH QUESTION & RESEARCH HYPOTHESIS
The decision to seek healthcare is significantly influenced by an individual's knowledge, attitudes, and education This study primarily aims to explore how the educational level of adults affects their tendency towards self-medication when they experience illness.
The study examines how sociodemographic factors and healthcare provider attributes affect self-medication behaviors among patients in Ho Chi Minh City This research aims to provide valuable insights for health policymakers focused on enhancing appropriate access to self-medication in the public sphere.
Research Question and Research Hypothesis
Higher education enhances individuals' ability to access and critically evaluate information, leading those with advanced education to possess greater self-confidence in their medical knowledge Consequently, individuals with higher educational levels are more likely to engage in self-medication compared to those with lower educational backgrounds This dissertation seeks to explore this relationship further.
- Are adult individuals with higher years of schooling more likely to be self-medicated facing typical diseases?
And the research hypothesis is:
- There is positive relationship between the level of education and the self-medication practices.
RESEARCH METHODOLOGY
This study will utilize descriptive statistics and an econometric model to address the research question Descriptive statistics will examine the relationships between independent and dependent variables, focusing on patients' knowledge and attitudes toward self-medication through numerical summaries and graphical representations Additionally, the econometric model will analyze the impact of various factors on self-medication behavior.
This study analyzes the behavior of individuals who utilized healthcare services, such as visiting a doctor or pharmacy, at least once in the past three months during periods of illness It recognizes that patients may seek medical assistance multiple times when unwell, making the focus of the analysis the frequency of visits to healthcare providers rather than the individuals themselves.
The analysis utilizes cross-sectional data from a household survey conducted by the author in Ho Chi Minh City, which involved structured interviews This primary data encompasses 120 patients and 227 interactions with healthcare providers, resulting in 227 observations for regression analysis performed using Stata 8.
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 Viet Nam health care and drug utilisation This chapter focused on providing the information about self- medication practice in Viet Nam 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.
LITERATURE REVIEW
SOME DEFINITIONS
The Vietnam National Health Survey (2002) defines self-medication as the practice of patients using medications without a doctor's examination or prescription This includes instances where patients, after receiving treatment from a physician, choose to buy additional medications independently rather than seeking a follow-up consultation.
The World Health Organization defines self-medication as the use of medications or consultations with pharmacies to address self-diagnosed conditions, as well as the ongoing or resumed use of prescribed drugs for chronic or recurrent illnesses without prior consultation with healthcare professionals (WHO, 2001).
The two definitions are largely similar in meaning; however, the latter offers a more detailed explanation of self-medication cases This study will adopt the World Health Organization's definition.
This study defines professional health care providers as individuals with specialized health knowledge who offer consultation or treatment These providers may work in various settings, including district hospitals, provincial hospitals, central hospitals, state facilities, private practices, clinics, and hospitals, encompassing both Western and traditional medicine.
This study categorizes illnesses into three types: (1) chronic severe illnesses, such as cancer and cardiopathy, that require medical examination and continuous monitoring; (2) common ailments like headaches and the flu, which can often be managed through self-care; and (3) conditions like angina and gastritis that necessitate a doctor's consultation before treatment According to Dr Nguyet from ShiHospital and Dr Quang from Due Chinh Clinic, these diseases demand specialized treatment, including careful consideration of dosage and medication combinations, such as antibiotics or steroids While these illnesses may not be life-threatening, improper treatment can be detrimental to both patients and society, highlighting the importance of professional medical advice.
This study focuses on individuals who experienced illnesses for less than 30 days in the past three months, specifically targeting angina, tonsillitis, and gastritis These conditions were selected based on health statistics from the Department of Health of Ho Chi Minh City, which indicate that they are among the most commonly treated diseases in local hospitals.
This section reviews consumer theory, which serves as the foundational framework for understanding the determinants of demand for health care services It then presents two widely used theoretical models for analyzing health care demand: Grossman’s human capital model and Andersen’s behavioral model.
1.2.1 Theory of consumer behaviour and the demand for health care services
Jack (1993) explored the demand for health care services within a traditional utility-maximizing framework, positing that individuals prioritize their health and select health care providers as the sole means of health production He analyzed how health status, income, and prices influence the demand for medical care, suggesting that individuals allocate their limited budgets to acquire a combination of goods and medical services that maximizes their overall satisfaction In this context, health is considered one of several commodities in the consumer's preference bundle.
The utility function is represented as U(c,h), where c signifies the alternative goods consumed and h indicates the desired level of health It is assumed that medical care is the sole input for health production, requiring 6 units of medical care to yield one additional unit of health With a budget constraint of c + 8h < qm, where both consumption and medical care prices are set at unity, an increase in health status index d—from 1 to 2, for instance—implies a decline in health, necessitating more medical care and causing the budget line to shift inward The elasticity of demand for health, ranging from 0 to 1, suggests that individuals prefer to allocate more resources towards health and reduce consumption of goods when experiencing illness.
When an individual encounters a specific number of healthcare providers, and if we assume that the cost associated with each provider is unaffected by the individual's health status, the budget lines depicted in Figure 2.1 illustrate the potential health outcomes.
9 consumption bundles combined with a given provider in the two different states of health are aligned vertically.
Figure 2.1: Available Health consumption bundles for individuals with different health status
Decisions regarding the selection of medical services are referred to as discrete choices, and discrete choice econometric models are utilized to estimate these preferences For instance, in Figure 2.1, an individual selects a healthcare provider based on their health status; when experiencing a more severe illness, they tend to prefer a different provider.
The effect of income on provider choice
Health and healthcare are generally considered normal goods; however, an increase in an individual's income can shift their budget constraints, leading to a higher demand for medical providers, assuming all other factors remain constant In cases where preferences are quasilinear regarding consumption goods, income does not influence individual choices of medical providers, indicating that health may not function as a normal good in this context.
Figure 2.2: Effects of Income on Provider choices
The effects of price on discrete demand
Figure 2.3: Effects of Price on Provider choice
When healthcare providers increase their prices, it leads to a significant reduction in the consumption of their services, resulting in a downward shift in the budget line for purchased healthcare This change indicates that individuals will consume fewer health services at higher prices, as their health-consumption bundles are horizontally displaced based on their income and health status Ultimately, the assumption is that price changes affect health improvements uniformly, but higher prices result in a more considerable decrease in service consumption.
The theory of consumer behavior offers insights into health care demand by assuming that individuals seek to maximize utility through choices that yield the greatest expected benefits However, this approach primarily focuses on analyzing outcomes rather than the decision-making process itself, presenting both advantages and disadvantages in understanding health care consumption.
Z.2.2 Grossman’s theory of human capital and the demand for health care
The Grossman model illustrates how individuals act as producers of health by strategically allocating their resources to enhance their well-being This approach emphasizes the investment in human capital, particularly in health and education, to achieve better outcomes in both the market and non-market sectors of the economy.
12 where he works and earns money, and non-market sector of household, where he produces commodities that enter his utility function.
The utility function of a typical consumer is
EMPiRICAL STUDIES
This section presents two models that utilize discrete choice econometric methods based on consumer theory to estimate the likelihood of utilizing medical services and specific types of healthcare providers.
This study examines how individuals in Vietnam decide between self-medication and seeking professional healthcare, utilizing data from the Vietnam Living Standards Survey (VLSS) conducted in 1997-1998 It posits that individuals with a specific income level (y) will select a combination of health status (h) and consumption (c) to maximize their overall utility, guided by a defined utility function.
To enhance health status, individuals can choose between two healthcare providers: professional care (U) and self-medication (Q) This model emphasizes the decision-making process regarding healthcare provider selection, with the price of professional care (P) normalized to one Consequently, this simplification allows for a clearer understanding of the budget constraint in the healthcare decision-making equation.
(2.5) is also the relative price of self-medication Q to professional care V.
The consumption function can be derived from (2.5):
Suppose that h is initial health status of an individual, the function of health level of one is:
The analysis indicates that utilizing professional medical care yields a positive return, while self-medication presents a lower return due to potential medication errors stemming from misdiagnosis Given that self-medication is associated with a random variable that has an expected value greater than zero, it suggests that patients opting for self-treatment may experience less effective outcomes compared to those receiving professional care.
Substituting (2.6) and (2.7) into the utility function U(c,h), we yields the general indirect utility function:
The welfare of an individual is influenced not only by their consumption of goods other than health care but also by their anticipated health outcomes, which are determined by financial investments in professional medical treatment and self-care practices.
A model analyzing data from Kenya illustrates how individuals confront illness when selecting from various healthcare options, including government providers, private facilities, other health services, and self-care This model proposes that individuals' utility functions are influenced by their health conditions, guiding their choices among these alternatives.
Where H;t is health status of one who chooses health care providers for treatment when being illness, C,b is the consumption of all other goods. And the health production function is
This equation shows that the expected improvement of health status depends on attributes of an individual I, and Z, the quality of health care provider j received by the individual.
The consumption function illustrates how an individual's income (Y) and the costs associated with purchasing treatment from a healthcare provider (Pj) influence their consumption levels This relationship highlights the impact of income and medical expenses on the healthcare consumption behavior of individuals.
By substituting the health status equation (2.10) and the consumption function (2 11) into the utility conditional function (2.9), it gains a general utility function
The equation (2 12) describes an individual can gains the benefits from choosing a typical health care provider under conditions of characteristics of
20 an individual I, the attributes of the provider Z, the individual’s income Y, user fees P paid for visiting provider
To determine the probability of choosing a typical health care provide, the authors adopted a linear utility specification, then the general utility function may be rewritten as follow:
The utility function, represented as Ph, incorporates both individual attributes and the quality of healthcare providers, while s signifies the residual component.
Let HCP; is health care provider indicator, the health care provider choice of an individual may be presented as
The individual / will choose the health care provider if the expected utility received from it is higher than the other ones.
MODEL SPECIFICATION
This chapter provides definitions of two providers of medical service in this study, self-medication and professional health care provider, and types of
This study explores the impact of education on health-seeking behavior among patients facing 21 different illnesses By reviewing three theoretical models of healthcare demand and relevant empirical studies, the research aims to provide insights into how educational factors influence individuals' choices in seeking medical care.
Consumer theory views health as one of many commodities influenced by individual preferences, whereas Grossman's model positions health as a stock variable within the human capital framework In this context, human capital theory suggests that the measures reflecting the consumption value of improved health are minimal, while consumer theory allows for a more straightforward observation and quantification of health service demand (Jack, 1993) Additionally, Andersen's model offers a comprehensive approach to understanding the various factors influencing the utilization of health services.
The empirical study by Chang and Trivedi, discussed in section 2.3, explores how individuals allocate their income between self-medication and professional health care providers However, it does not address health care choices in the context of illness The study provides insights into the decision-making processes of individuals regarding their health care options.
”pertain only to public facilities”, in case of multiple health care providers.
Thus, constructing an appropriate empirical model to answer the research question needs some justifications based on the above analyses about theoretical framework and empirical studies.
It’s assumed that an individual when being illness will have to choose between self-medication and professional health care provider, the utility from the two alternative providers:
In the context of consumer behavior, the equation (2.11) illustrates that consumer preferences (I) are influenced by the quality of the provider (Z) and unobserved components (c) It is assumed that consumers will opt for self-medication when the expected utility from this choice surpasses that of seeking professional healthcare.
Where =/ if individual choose self-medication and — 0 for professional health care To estimate the probability of choosing self-medication, the equation should be:
It’s assumed that the utility function is linear; the equation (2.18) is separable in deterministic and stochastic preference:
The deterministic part of utility can be presented as follow:
The deterministic component of an individual's utility function when selecting a health care provider is influenced by the individual's income, the costs related to obtaining health care, personal characteristics, and the quality of the health care provider.
From the equation (2.20), the deterministic part of utility from self- medication is:
And the utility from professional health care provider is:
As mentioned before, the utility function is linear, thus the marginal utility of income of an individual in the two situations should be identical:
The probability statement (2.24) could be rewritten as follow:
The probability function indicates that an individual's decision to choose between self-medication and professional healthcare is influenced by the cost differences, personal preferences, and the characteristics of healthcare providers Consequently, this leads to the formulation of a regression function.
In our regression analysis, the dependent variable is binary, representing self-medication as one and professional health care providers as zero Given the nature of limited dependent variables, ordinary least squares regression is unsuitable due to various econometric issues To address these challenges, nonlinear estimation techniques such as probit and logit analyses are employed The probit model utilizes the cumulative normal function, while the logit model relies on the logistic function, both applying maximum likelihood estimation However, the logit model is preferred in this study due to its lower computational cost (Long, 1997) Thus, we utilize the binomial logit model to analyze the discrete variable effectively.
In healthcare decision-making, patients face two alternatives: self-medication (r = 0) and professional care (r = 1) The probability (P) of choosing between these options is influenced by various factors, including price differences (I), individual characteristics (If), and the attributes of the healthcare providers (Z3) The regression function highlights how these elements impact patient choices when confronted with illness.
2.4.2 Transforming theoretical framework into variables
Table 2.1 List of variables and Expected Signs
Variables Description Expected signs choice =1 Self-medication, professional health care — 0
Difference in price (X] difpri Difference in cost for getting medical services
Characteristics of individual (Xz1 edu Completed years of education age Age in years gender =1 Male; =0 Female married —1 if married; = 0 otherwise dayill Number of days of illness
The attributes of healthcare providers significantly impact the quality of medical services received A key factor is the time taken to access these services, which can influence patient outcomes Patients believe that their recovery would be expedited if they received consultations from professional healthcare providers, indicating a strong correlation between provider quality and patient satisfaction.
The left hand side of regression function (2.27) is a dummy variable referring to the choice of an individual /, 1 for self-medication, 0 for visiting doctor.
Research on the impact of price on health care seeking behavior has yielded mixed results Studies by Litvack and Bodart (1993) and Lavy and Germain (1994) indicate that price significantly influences health demand Conversely, findings from Lacroix and Alihonou (1982) and Akin et al (1998) suggest a different perspective, highlighting the complexity of this relationship.
WB (1987) concluded that price has relatively little influence on health care demand.
The price of medical care encompasses not only the direct monetary payments for goods and services but also additional expenses such as lost income and travel costs For consumers enrolled in health insurance, these factors can significantly impact their overall financial burden.
The consumption of medical services among individuals in informal labor markets, particularly those without health insurance, is minimal or negligible Jack (1997) highlights that travel costs can serve as a valuable tool for researchers examining health care demand when there is limited variation in monetary prices Additionally, Gertler and Van der Gaag (1990) utilized travel costs as the sole measurable expense in their health care study.
This study examines how educational levels influence individuals' choices of healthcare providers Due to data collection limitations, travel costs are assumed to be zero Consequently, the costs associated with self-medication in this analysis include only the monetary expenses for purchasing medicines For those consulting professional healthcare providers, the costs encompass both the price of prescribed medications and consultation fees.
The price difference between self-medication and visiting a doctor is determined by subtracting the total cost of self-medication from the total cost of a doctor's visit This price disparity is anticipated to positively influence the likelihood of individuals opting for self-medication instead of seeking medical advice.
This part will introduce variables of individual characteristics which affects his or her choices about what kind of medical services into econometric model:
Age is quantified by the number of years lived, with research indicating varying impacts on self-care and self-medication practices A study conducted in Kenya by Bedi et al (2003) utilizing multinomial logit analysis found that younger individuals are more inclined to rely on self-care Conversely, research by Chang and Trivedi (2003) in Vietnam revealed a positive correlation between age and the likelihood of self-medication.
CONCLUSloN
This chapter presents essential definitions of key concepts such as self-medication, professional health care providers, and types of illness, alongside a theoretical framework for understanding the demand for health care services It discusses three theoretical models, highlighting that consumer theory views health as a commodity influenced by individual preferences, while Grossman’s model considers health as a stock variable within the human capital framework Additionally, it suggests that human capital theory employs specific measures to reflect the consumption value of health care services.
Improved health status sets lower bounds for health service demand, which is more readily quantifiable within consumer theory (Jack, 1993) Andersen’s model effectively integrates various concepts related to the utilization of health services This chapter presents two empirical studies that further support the development of the empirical model.
In short, based on theoretical framework, there are three groups of variables in the empirical model: difference in prices, characteristics of patients and attributes of health care providers.
VIETNAMESE HEALTH CARE AND DRUG UTILAZATION
CONCLUSION
Despite Vietnam's impressive economic growth, with GDP doubling every decade over the past twenty years, it remains relatively impoverished According to UNDP data, Vietnam's Human Development Index (HDI) improved significantly, rising from 120th in 1995 to 108th in 2005 among 177 countries This indicates Vietnam's commitment to not only fostering economic development but also enhancing its healthcare sector.
Vietnam's healthcare system is undergoing significant transformation, driven by the rise of the private healthcare sector and pharmaceutical industry, which has altered health-seeking behaviors among households and individuals However, the government's lack of preparedness to regulate and monitor the quality of care and medications provided by these private entities has resulted in negative consequences, including the spread of antibiotic resistance With a population exceeding 80 million, health insurance in Vietnam has the potential to effectively target large groups and distribute risk more efficiently.
2005) However, the proportion of insured individuals is not high, just covers
The government is enhancing public health insurance systems to improve access to healthcare facilities for 12 percent of the population by utilizing insurance cards more effectively.
Self-medication is the most prevalent health-seeking behavior in Vietnam, primarily driven by the perception that illnesses are minor and do not require professional consultation This practice is not unique to Vietnam, as it is also widespread in developed countries However, the safety and appropriateness of self-medication raise concerns Economic factors play a significant role, particularly among low-income individuals or those with limited education, who often believe that the costs of medical examinations outweigh the expenses of purchasing medications.
SELF-MEDICATION BEHAVIOUR OF PATIENTS IN HO CHI MINH CITY
DATA COLLECTING METHOD
The analysis utilizes cross-sectional data gathered from a household survey conducted in Ho Chi Minh City through structured interviews To manage time and budget constraints, the survey randomly selected three inner districts: District 1, District 3, and Tan Binh District The sample size was determined using the formula provided by Mason (1999).
Where: ii is the size of the sample; p is sample proportion;
Z is the standard normal value corresponding to the desired level of confidence; fi is the maximum allowable error.
Since the term p(1-p) is maximized at p = 0.5 and p is not identified, the value of p is set at 0.5 Z equals 1.96 at the level of confidence of 95% and E
Applying the Equation (4.1), the sample size needed is equivalent 97.
The sample size for this study was established at 120 to accommodate the logit model used to address the research question Long (1997:54) recommends a minimum of 10 observations per parameter for effective maximum likelihood estimation Details regarding the econometric model can be found in section 2.4.1.
Primary data for the study was gathered through face-to-face interviews in Ho Chi Minh City, utilizing a structured questionnaire A pilot survey involving 30 respondents was conducted to pre-test the questionnaire prior to the main survey Each interview lasted approximately 25 minutes and took place in the respondents' homes The main survey, conducted over four weeks in May 2007, included interviews with 120 patients, resulting in a total of 227 medical service contacts.
The questionnaire is divided into four sections aimed at gathering essential information The initial section includes questions that evaluate respondents' knowledge of drug safety and their attitudes towards self-medication, developed based on the guidance of Dr Nguyet and Dr Quang from ShiHospital in Ho Chi Minh City Prior to advancing to the next section, respondents are asked if they have experienced any illnesses in the three months leading up to the survey; if their illnesses are not listed or if they have not utilized any medical services, the interview will not proceed.
In the second part of the survey, respondents reported the number of days they experienced illness, the types of healthcare providers they consulted, the frequency of their visits, and their evaluations of the quality of prescriptions received.
The third section of the study focused on gathering patient information regarding the characteristics of their chosen healthcare providers and the expenses incurred for medications and consultations Respondents were categorized into three distinct groups based on their selected medical services: (1) those who opted for self-medication only, (2) those who consulted a doctor only, and (3) those who utilized both services Initially, groups (1) and (2) were posed questions about their actual medical service choices, followed by similar inquiries under the assumption that they had selected alternative providers (refer to appendix 1) This approach aimed to mitigate the risk of missing data from patients who relied solely on one type of medical service.
The last part consists of questions to observe individual’s characteristics such as education, age, gender, marital status, ethnic, occupation, etc.
DESCRIPTIVE STATISTICS
Of the 120 patients were interviewed, 94 respondents reported that they were gastritis and 26 that were angina in the last 3 months.
Variable mean min max sd
The number of days of illness 7.45 1 30
Table 4.1 shows the description of demographic variables There are 21 respondents (17.5%) reported that they were up to primary education, 47 (39%) above primary or up to secondary, 25 (21%) went to high school and
Among the respondents, 22.5% are currently enrolled in college or university, with an average of 9.45 years of education, ranging from 2 to 16 years The age distribution shows that 31.7% are between 18-25 and 26-35 years old, while 21.6% fall within the 36-45 age bracket, and 15% are over 45, resulting in a mean age of 33.22 years The gender distribution is balanced, with an equal number of male and female respondents, and 38% identifying as single On average, respondents reported 7.45 days of illness, with a range from 1 to 30 days Additionally, 39% of respondents indicated they are enrolled in a health insurance program.
Table 4.2 : Demographic Information of Respondents by behaviour group
Self-medication only Visiting doctor only
To describe behaviour of individuals facing illness in more detail, the survey data was divided into 3 groups of behaviour: group 1 for those who only
In a study involving 120 respondents, participants were categorized into three groups based on their healthcare choices: Group 1 consisted of 60 individuals who opted for self-medication, Group 2 included 24 individuals who exclusively visited a doctor, and Group 3 comprised 36 individuals who engaged in both self-medication and doctor visits Detailed demographic information for these groups is presented in Table 4.2.
Table 4.2 indicates that respondents with a secondary education level represent the largest group among the three categories Notably, individuals with a college or university education are more inclined to self-medicate, with 28.3% in group 1 compared to only 4% in group 2 Conversely, those with a primary education level show a higher tendency to seek medical advice, with 100% in group 1 and 34.6% in group 2 This suggests that individuals with higher educational attainment prefer visiting pharmacies over consulting doctors.
Self-medication seems to be more prevalent with the younger age groups, 18
In the age groups of 25-26 and 35, there is a notable distribution of 42% and 32% respectively, with a higher proportion in group 2 indicating a greater likelihood of visiting professional healthcare providers Descriptive statistics reveal that males, singles, and the uninsured tend to rely on self-medication, while females, married individuals, and those with insurance are more inclined to seek consultation from professional healthcare providers.
When the number of days of illness is less than 7 days, patients are more likely to choose self-medication However, they prefer visiting doctor if the
In this paper, we categorize patients into three groups: Group 1 for those practicing self-medication, Group 2 for those visiting a doctor, and Group 3 for individuals engaging in both behaviors The duration of illness observed ranges from 7 to 14 days, with a notable shift in patient choices occurring when the illness extends beyond two weeks, leading to a transition from self-medication to seeking medical attention.
A significant 58% of respondents seek medical advice from non-practitioners, indicating a strong tendency to rely on the experiences of friends and family when addressing their health issues.
Table 4.3: Change in choosing health care providers of Group 3
Treatment Self-medication Professional HCP
Group 3's health care choices reveal significant consumer behavior patterns during illness Initially, individuals in this group prefer visiting pharmacies, with consultations from doctors occurring later When faced with ongoing treatment, they often resort to self-medication instead of seeking medical advice, primarily relying on previous prescriptions to purchase medications independently.
4.3.2 Price and attributes of health care providers
Table 4.4: Total cost of treatment by behaviour group
TOTAL COST Mean Std Dev Min Max
Table 4.4 presents a comparison of healthcare provider costs among three behavioral groups, highlighting expenditures on medications and consultation fees According to Table 4.6, group 1 incurs the lowest forgone consumption costs, while groups 2 and 3 face significantly higher monetary payments, averaging three to four times more than group 1 This increase in costs is attributed to the additional consultant fees and longer average illness durations in groups 2 and 3, leading to more frequent visits and higher drug expenses compared to group 1.
Table 4.5: Total consuming time of treatment by behaviour group
TOTAL TIME Mean Std Dev Min Max
* Note time 1.’ two-way travel time to clinics or hospitals, time2.- waiting time encountered at clinics or hospitals,’ time3.’ time seeing doctor
The time spent on medical services is equated to monetary costs, with Group 1, which relies solely on self-medication, reporting the lowest mean time In contrast, Groups 2 and 3 account for additional factors such as travel, waiting, and consultation times Notably, Group 2 experiences a longer mean travel time due to the greater distance to healthcare facilities compared to pharmacies Meanwhile, Group 3 shows similar mean times for self-medication and professional healthcare services, with 16 minutes and 14 minutes respectively for self-medication, and 63 minutes compared to 70 minutes for professional care.
Self-medication is often viewed as a cost-effective and time-saving approach for managing illnesses, which contributes to its widespread use among individuals However, this practice carries significant risks, particularly when patients lack adequate knowledge about drug safety The following section will examine respondents' knowledge and attitudes regarding self-medication.
4.3.3 Knowledge of drug safety of respondents
To access respondents’ knowledge level of drug safety the questionnaire has ten questions, question 1 to 10 The detailed responses are shown in Appendix 2.
Table 4.6: Knowledge of drug safety by behaviour group
Table 4.6 illustrates the varying prevalence of correct answers concerning drug safety knowledge among different behavior groups, with correctness rates ranging from 14% to 83% Notably, question 7, which addresses the use of antibiotics for inflammation or infection, and question 3, concerning the reuse of previous prescriptions, received the lowest correct response rates at 14% and 19%, respectively.
A study involving 120 participants revealed that 33% disagreed with discontinuing antibiotics once symptoms improved, while 56.7% agreed, and 11% were unsure Van Duong et al (1997) identified the belief that antibiotics are toxic as a primary reason for not completing prescribed courses This inadequate usage has contributed to the widespread emergence of antibiotic resistance in Vietnam, resulting in longer, more severe illnesses and increased costs and mortality rates (WHO, 2001) Furthermore, a significant number of respondents (51% for fever/headache and 59% for cough/cold/headache) supported the inappropriate use of antibiotics, highlighting the ongoing misuse of these medications in Vietnam (Van Duong et al., 1997; Ha, 1991).
However, most of people show positive attitudes toward the necessity of prescription when using antibiotics, 76 (63%) disagree with the statement
Many individuals can purchase antibiotics for treatment without a prescription, and approximately two-thirds of respondents reported reusing previous prescriptions for similar symptoms to avoid consultation fees This behavior aligns with the common practice of self-medication among the respondents Additionally, a significant majority, 79% and 82.5%, acknowledged the importance of using prescribed medications until finished and adhering to follow-up examinations as recommended by their doctors.
Table 4.7 Knowledge of drug safety by behaviour and educational group
Educational level Behaviour group Total
Table 4.7 presents the average scores for drug use knowledge across different behavioral and educational groups The mean scores for Groups 1 to 3 on the knowledge questionnaire are relatively low, recorded at 4.9, 5.5, and 5.1, respectively This suggests that individuals who have consulted a doctor may possess a better understanding of appropriate medication use.
59 the mean scores increase with educational level, these figures strongly indicate that respondent’s knowledge level was less than satisfactory With a maximum score of 10, the total mean scores is only 5.2.
This study explores individual choices between utilizing pharmacy services and seeking care at clinics or hospitals when faced with illness, examining the factors influencing these decisions The analysis focuses on the frequency of visits to medical services, specifically pharmacies and clinics/hospitals The research is based on household survey data collected from 120 participants, resulting in 227 interactions with healthcare providers This section will present the regression results and their interpretations.
RECOMMENDATIONS
Self-medication is a widespread practice in both Vietnam and developed countries, valued for its convenience, time-saving, and cost-effectiveness in treating common illnesses However, the safety and appropriateness of self-medication depend on proper guidelines To enhance public health outcomes, it is essential to regulate drug distribution through pharmacies and vendors, supported by clear goals, policies, and continuous education for healthcare providers This study presents several recommendations aimed at maximizing the benefits of self-medication while minimizing its associated risks.
Governments should enhance public medical education programs to increase awareness of drug use and safe medication practices This initiative will empower individuals to make informed decisions regarding their health Currently, there is insufficient information available about the risks associated with the misuse of nonprescription medications and the potential harm they can cause.
The lack of awareness regarding public health issues among society and individuals highlights the need for enhanced medical education, particularly among educated populations There is a pressing requirement to address misconceptions about health, especially concerning safe drug use and the risks associated with antibiotic resistance Utilizing various communication channels, such as television, radio, and newspapers, can significantly improve public understanding As noted by Pardes et al (1996), community-focused education is crucial, given that patient demand and societal expectations greatly influence healthcare practices The findings of this study indicate that public medical education initiatives should specifically target younger individuals under 45, particularly those who are single and female, to maximize impact.
In Vietnam, despite regulations requiring prescriptions for certain drugs and antibiotics, many potentially dangerous nonprescription medications and all antibiotics remain readily accessible at pharmacies and drug outlets To address this issue, there is a pressing need for enhanced enforcement of regulations and improved monitoring systems to reduce irrational medication practices.
To minimize risks and maximize the benefits of self-medication, it is essential to strengthen the partnership between doctors, pharmacy staff, and patients Health care providers are crucial in promoting safe medication practices, and they should focus on educating customers effectively.
To ensure safe medication use, it is essential to provide consumers with accurate medical information and guidance on self-medication practices By promoting responsible drug use, particularly with prescription-only medications and antibiotics, individuals can enhance their understanding and improve their medication habits.
Easy access to professional healthcare providers significantly boosts the demand for medical examinations when individuals fall ill By minimizing waiting times in clinics and hospitals, this approach addresses the growing preference for valuing time over cost among patients.
In 2002, less than 20 percent of Vietnam's population was covered by social health insurance, primarily benefiting wealthier groups such as civil servants and established formal sector employees The Vietnam National Health Survey (VNHS) 2001 indicated that insured individuals utilized private healthcare services less frequently, as insurance primarily covered public facilities However, a World Bank study from 2001 highlighted the significant role of the private sector in providing outpatient services Enhancing the official role of the private sector in health insurance programs could improve the overall efficiency of healthcare professionals in Vietnam.
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