Factors influencing healthcare facility selection in an urban setting in Lao PDR: Findings from a qualitative study

Abstract

Background

In Lao People’s Democratic Republic (Lao PDR), health care is provided through a public system comprised of central, provincial and district hospitals, health centers, and a growing private sector. Despite efforts to strengthen primary care, recent data suggests that Laotians often bypass primary care facilities. This study aims to understand the factors influencing health facility selection in an urban setting in Lao PDR.

Methods

We conducted a qualitative study using 16 focus-group discussions in four districts in Vientiane capital. Guided by Constructivist Grounded theory, we analyzed the findings using the Framework Method.

Results

The study revealed several key factors influencing health facility selection among urban residents of Vientiane capital. Accessibility of care facilities was a primary consideration. Participants preferred tertiary-level hospitals because of their perceived clinical superiority and modern amenities, however, they were unsatisfied with long waiting times, confusing procedures, and demands for informal payments. Lack of respect and empathy drove participants to private providers, which were perceived to be efficient and friendly.

Conclusion

We found that key factors influencing facility selection included accessibility, perceived severity of illness, cost, perceived clinical competence of health workers, respectfulness of health workers and staff, standards of health facilities, timeliness of care and personal connections. Among the key findings of this study was that lack of respect and empathy drove individuals towards private providers, which were perceived to offer a friendlier atmosphere. This study underscores the need to consider primary care models that foster a culture of respect and empathy.