Health service transitions among Chinese, Hmong, Lahu and Northern Thai in an era of universal health insurance: ethnoepidemiology and use of traditional and modern health services in North Thailand
Peter Kunstadter (Program for HIV Prevention & Treatment)
Paper short abstract:
Health insurance only partly explains significant ethnic differences in health problems and their causes, and in respondents' use of modern vs. traditional health services as reported by 1327 Chinese, Hmong, Lahu and Northern Thai young adults in a rural area with heavy trans-border migration.
Paper long abstract:
To what extent does universal health insurance help reach the goal of "Health for All" by eliminating or significantly reducing health and health service disparities between ethnic groups within similar health service environments? Does traditional medicine "survive" when modern services are readily accessible, and does its survival vary in association with different cultural traditions? To what extent are transitions in health and health services influenced by socio-economic-geographic factors in addition to direct costs of health care (e.g., education, income, religion, transportation) or by socio-cultural factors (e.g., ethnicity-associated beliefs, acculturation and integration with the predominant local society)? As one step in answering these questions, data on major health problems as perceived by respondents, their perceived causes, and respondents' use of modern and traditional health services were collected from 1327 Chinese, Hmong, Lahu and Northern Thai young adult women and men in an ethnically diverse rural border area with large numbers of trans-border migrants. Analyses show significant differences between ethnic groups, between men and women of the same ethnic group, and within Chinese and Lahu groups, between migrants and citizens in perceived health problems, use of traditional vs. modern health services, and in constraints to use of modern health services. Differences are only partially associated with economic conditions and eligibility for health insurance, and are reduced, only in part, by acculturation (e.g., Thai language ability). These results suggest the need for tailoring health services including health education to different ethnic groups in order to reduce health and health service disparities.
Medical anthropology into the future: aspirations and challenges (Commission on Medical Anthropology and Epidemiology)