Factors affecting the utilization of public health care services among households in Lahore district, Pakistan

The contemporary research literature, in the case of the public health care system in Pakistan, has continuously reported that the public health care services offered to the citizens of the country are underutilized. However, many factors motivate or trigger the utilization of public health care services among the citizens. A public health care unit is an integral part of a social and medical organization, the function of which is to provide for the population complete health care curative and preventive. Increasing awareness of the general public regarding healthcare issues, public expectations from healthcare providers, availability of multiple healthcare resources to some people and increasing costs of treatment all have a definite bearing on the utilization of health care services from public healthcare units. There are various problems faced in utilization of public health care services like availability of equipment’s, overcrowding, delay response in emergency, cleanliness and lack of proper guidance that creates a lot of problems for the patients and for this purpose following study was aimed to determine the factors affecting the utilization of Public healthcare services among the household of the Lahore District. The objectives of the study is to determine the factors affecting the utilization of public healthcare services among household of Lahore District. It was cross-sectional based study in Lahore district. A total of 500 household heads of Lahore district were included. Households were selected from Union councils, where there were about 1500- 2000 houses in each union council. Proportionate random sampling technique was adopted and information was gathered using validated and reliable self-administered questionnaire. The dependent variable was utilization of health care services and independent variables were sociodemographic factors, healthcare facility factors and environmental factors. Data was analyzed through SPSS 23.0. Frequencies and percentages were calculated and data was presented in tables and figures. Chi-square test was used to measure association and Multinomial Regression analysis was used to determine predictors. Among 500 respondents, 77.0% were males and 45.8% were 21-30 years old. Respondents with matriculation certificate had high percentage (40.6%) and 87.8% respondents has family monthly income <25,000 PKR rupees. Respondents who visited health care facilities two times during last four illness spells was reported as 45.8%. Among respondents, 88.6% confirmed the availability of duty doctors, 21.8% were satisfied with medical examination and 70.4% were prescribed medical test while 18.4% were suggested by staff to go to any private clinic for test. Only 15.2% respondents said that behaviour of hospital staff other than doctors/medical professionals was satisfactory, 58.0% respondents waiting time for consultation in emergency was <1/2 hour, 63.0% were given medicine and advised fully about the disease, 23.2% respondents faced problem in getting bed, 24.2% got operation accessories/medicines from hospital and 28.4% were advised about follow up visits. Amounting 24.6% respondents said they will visit again to the public health care facility. As many as 88.4% respondents confirmed that proper sitting is available in waiting area of healthcare unit, 84.6% said cleanliness was satisfactory and 22.0% said clean water for drinking was available while 23.4% respondents said that washrooms of healthcare facilities were neat and clean. In accordance with the findings, family income affected the hospital visits significantly (AOR: 2.917; 95% CI: 0.000-1.35x10⁴⁶). Given this, the impact of education of respondents is also computed to be significant (AOR: 0.64; 95% CI: .239-3.76 at option5). The behaviour of hospital staff was also significant (AOR: 0.898; 95% CI: .416-1.93) and the effect of cleanliness (AOR: 1.51; 95% CI: .753-2.53). Lastly, the effect of waiting time was also significant (AOR: 3.6; 95% CI: .395-3.29x10¹). The study showed that there was an association between socio-demographic factors, health-care facility factors and environmental factors with the utilization of public health care services among household head of Lahore district. Study revealed that gender and age do not predict the hospital visits, which implies that gender and age does not affect the number of visits by the patients to public health hospitals. it can be determined that irrespective of hospital conditions, and factors age groups and gender does not react as compared to the education, and family income. This is a new empirical finding that education affects the behavior of patients, and as does family income; thus a person with higher education and enough salary to afford private treatment will not make as frequent visits as others who are less educated and have less salary comparatively. Furthermore, the waiting time in emergency, behavior of doctors and paramedical staff, environment of the healthcare facility also significantly predicts the number of visits of patients.

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