Accessibility of health care service in different health care settings: a case study of tuberculosis patients
Tuberculosis (TB) continues to be an important public health problem in Thailand. Thailand is classified by the World Health Organization (WHO) as one of the 14 countries in the world with the highest TB burden. Despite advances in tuberculosis and AIDS treatment to the extent that morbidity and mortality rates from tuberculosis and AIDS have significantly been reduced, the challenges still remain as evidenced by a delay to recruit TB patients into the existing TB treatment and management system, thus potentially leading to mortality among tuberculosis patients. Objectives: This study aimed to determine and compare the accessibility of patients with tuberculosis to health care services in different health care settings in terms of availability, affordability, and acceptability. Method: This study used a descriptive cross-sectional design. The data were collected from 120 patients with tuberculosis who registered in four different health care settings, i.e. community hospital, general hospital, private hospital, and office of disease prevention and control, during October 2017 - January 2018. A questionnaire was used to collect the three-dimension data of availability (7 items), affordability (7 items), and acceptability (6 items). The data were analyzed using descriptive statistics. Kruskal-Wallis test was used to compare the mean score of accessibility among four different health care settings. Results: There were 22 (18.33%) patients with tuberculosis participating in setting A; 79 patients (65.83%) were from setting B; 5 patients (4.17%) were from setting C; and 14 patients (11.67%) were from setting D. It was found that acceptability dimension had a highly satisfactory level (x ̅ = 4.29±0.60), followed by availability dimension with a moderately satisfactory level (x ̅ = 3.84±0.66), and affordability dimension with an unsatisfactory level (x ̅ = 2.86±0.86). In addition, levels of accessibility showed statistically significant difference among 4 health care settings for availability and affordability dimensions (p<0.05), but there was no difference among 4 health care settings in terms of acceptability dimension. Conclusion: Overall, of the three dimensions of accessibility, patients’ acceptance toward healthcare providers is the most important dimension, followed by availability dimension. Affordability is the least significant dimension on the accessibility of patients with tuberculosis to health care settings. To increase TB patients’ accessibility to health care services, it is important that both patients and healthcare providers build a mutually positive relationship. Health facilities should have in place an efficient service delivery system in terms of facilities, manpower, medicines, and turnaround time, while encouraging more active engagement from various organizations in the community in order to assist the patients with extra expenses in addition to medical bills.
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