Determinants of Health Seeking Behavior in Pakistan: A Complex Health Survey Design
The health care delivery system in Pakistan is complex in nature and limited resources are available for the health care sector. Hence it is important to understand the health seeking behavior of the population and trend of health services utilization in Pakistan. The study objective is as follow
- To investigate the determinants of health seeking behavior in Pakistan we suggest a multilevel pseudo maximum likelihood (MPML) approach to estimates model parameters for the complex survey design.
METHODS:
The sampling strategy of the National Health Survey was stratified two stage cluster sampling. Overall 18,315 subjects were interviewed. This is three level data with PSUs at the third level, household at the second level and persons at the first level. Health care utilization was considered as a binary outcome.
RESULTS:
We found age, gender, marital status, household ownership of durable goods, urban/rural status, community development index, and province as significant predictors of health care utilization (p-value <0.05). We also found two significant interactions; between gender and marital status (p-value<0.005), and between the community development index and urban/rural status (p-value <0.045).
The variances of the random intercepts are estimated as 0.135 for PSU level and 0.224 for HH. The results are significantly different from zero (p-value<0.05) and indicate considerable heterogeneity in health care utilization w.r.t to HHs and PSUs.
CONCLUSIONS:
The low economic status, illiteracy, lack of awareness, and cultural and social barriers create obstacles in health care utilization. It suggests that more health centers should be set up in rural areas. There is also a need to consider gender sensitive programs and other determinants which we have highlighted in our results to bring about significant changes to the health care system of Pakistan.