Publication Type

Journal Article

Version

Postprint

Publication Date

1-2008

Abstract

Vietnam's sustained investment in primary healthcare since the onset of socialism has lowered infant and childhood mortality rates and improved life expectancy, exceeding progress achieved in other poor countries with comparable levels of income per capita. The recent introduction of user fees for primary healthcare services has generated concern that economic policies may have adversely affected health-seeking behavior and health outcomes of the poor, particularly among impoverished families who are members of socially marginalized minority groups. This paper examines this debate by analyzing parental recall of illness and care-seeking for sick children under the age of 5 years recorded by the 2001-2002 Vietnam National Health Survey. We estimate statistical models of the determinants of parental recall of incidence and response to illness among their children. Ethnic minority parents less frequently reported their children to have been sick than Kinh and Chinese parents. When they recognize an illness episode, minority parents are less likely to seek care--whether professional consultation or self-prescribed care--than non-minority parents. Ethnic differentials are evident in all geographic and income levels, although adverse effects of minority status are most pronounced among poor households in remote areas. Regression estimates of the effects of ethnicity and maternal education on health decisions are pronounced even when poverty effects are controlled, suggesting that social equity may have been under-emphasized in Vietnam's early health policy deliberations. Policies extending free healthcare to poor communes affect parental decisions to seek professional care or self-prescribed care among better-off parents without affecting parental decision making among the poor. Early health initiatives for the poor may therefore have failed to offset equity problems confronting impoverished ethnic minority families.

Discipline

Asian Studies | Family, Life Course, and Society | Medicine and Health

Research Areas

Sociology

Publication

Social Science and Medicine

Volume

66

Issue

5

First Page

1118

Last Page

1130

ISSN

0277-9536

Identifier

10.1016/j.socscimed.2007.10.020

Publisher

Elsevier

Additional URL

http://dx.doi.org/10.1016/j.socscimed.2007.10.020

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