Health services utilization and cost in Ismailia, Egypt

A pilot study has been undertaken to assess the utilization patterns of health services and to estimate the expenditure on health care in the Governorate of Ismailia, Egypt. A stratified random sample of 89 households (576 individuals), along with 5 pharmacies, 4 primary health care units (PHCUs) and 10 traditional health workers (THWs) has been selected and studied using personal interviews. PHCUs are facilities affiliated with the Governorate Health Directorate and provide free public primary health care services. They include rural health units. rural hospitals and urban health centres. THWs are individuals with informal training and experience in medical care, and officially unrecognized, but provide some primary health care services to the people. They include traditional midwives (TMs) and traditional healers (THs). The estimated average annual per capita expenditure on health care was L.E.9.2 (Egyptian L.E. US$ 1.25). The per capita cost of medication (L.E. 3.5) was double the cost of physicians' fees (L.E. 1.77). An annual rate of hospital admission of 24.3 per 1000 population at an average cost of L.E. 10.5 per case admitted was incurred by the sample. There is evidence that the PHCUs have not been utilized efficiently and there was some degree of dissatisfaction with their services. The households relied more on private physicians as their first contact for seeking help for health problems. The majority utilized TMs for care of delivery despite the shortcomings in their training and supervision. Eighty per cent of the mothers in the sample have had no ante-natal care during pregnancy despite the availability of such care in the PHCUs. Possible reasons for these uderutilization patterns of the PHCUs have been discussed, and major approaches for increasing the efficiency and utilization of the health services have been proposed. THWs should be officially recognized by health authorities, should be properly trained and supervised, and their services should be fully integrated with the community health care programmes. Also, programmers for proper administration, organization and supervision of the PHCUs and programmers for developing health manpower responsive to community health needs should be planned and implemented. Finally, a flexible system to compensate fairly physicians and staff of the PHCUs and to allow reasonable chance for physicians for private practice must be established. Future studies for assessing the utilization and cost of health services in the Governorate may make use of these findings as a background for more elaborate designs. Such designs will include larger and more representative samples of health care providers and consumers and will utilize questionnaires and techniques that maximize the reliability and validity of the information sought. The findings of this study also may help in formulating health policy decisions at the Governorate level in Egypt.