Haenssgen, Marco Johannes and Ariana, Proochista (2017) Healthcare access : a sequence-sensitive approach. SSM - Population Health, 3 . pp. 37-47. doi:10.1016/j.ssmph.2016.11.008 ISSN 2352-8273.

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Abstract

It is widely accepted that healthcare-seeking behaviour is neither limited to nor terminated by access to one single healthcare provider. Yet the sequential conceptualisation of healthcare-seeking processes has not diffused into quantitative research, which continues to analyse healthcare access as a “one-off” event. The ensuing lack of understanding healthcare behaviour is problematic in light of the immense burden of premature death especially in low- and middle-income countries. This paper presents an alternative approach. Based on a novel survey instrument, we analyse original survey data from rural India and China that contain 119 unique healthcare pathways among 637 respondents. We offer three applications of how such sequential data can be analysed to enhance our understanding of people's health behaviour. First, descriptive analysis of sequential data enables more a comprehensive representation of people's health behaviours, for example the time spent in various healthcare activities, common healthcare pathways across different groups, or shifts in healthcare provider access during a typical illness. Second, by analysing the effect of mobile technology on healthcare-seeking process characteristics, we demonstrate that conventional, sequence-insensitive indicators are potentially inconsistent and misleading approximations when compared to a more precise, sequence-sensitive measure. Third, we describe how sequential data enable transparent and flexible evaluations of people's healthcare behaviour. The example of a sequence-insensitive evaluation suggests that household wealth has no statistical link to an illustrative “ideal” form of public healthcare utilisation. In contrast, sequence-sensitive evaluations demonstrate that household wealth is associated with an increased likelihood of bypassing referral processes and approaching unregulated and costly informal and private practitioners before accessing a public clinic. Sequential data therefore do not only reveal otherwise neglected locational idiosyncrasies, but they also yield deeper insights into the drivers of people's health behaviours compared to a conventional approach to “access to healthcare.”

Item Type:	Journal Article
Subjects:	H Social Sciences > H Social Sciences (General) R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Faculty of Arts > School for Cross-faculty Studies > Global Sustainable Development
Library of Congress Subject Headings (LCSH):	Health services accessibility, Health behavior -- Developing countries, Health behavior -- India, Health behavior -- China, Wireless communication systems in medical care, Sequential analysis
Journal or Publication Title:	SSM - Population Health
Publisher:	Elsevier
ISSN:	2352-8273
Official Date:	December 2017
Dates:	Date Event December 2017 Published 30 November 2016 Available 29 November 2016 Accepted
Volume:	3
Page Range:	pp. 37-47
DOI:	10.1016/j.ssmph.2016.11.008
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	15 November 2018
Date of first compliant Open Access:	15 November 2018
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID 122/670 John Fell Fund, University of Oxford http://dx.doi.org/10.13039/501100004789 SSD/2/2/16 [ESRC] Economic and Social Research Council http://dx.doi.org/10.13039/501100000269 Scatcherd European Scholarship (GAF1213_SES_511446) [UO] University Of Oxford http://dx.doi.org/10.13039/501100000769

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