Choice of health-care facility after introduction of free essential health services in Nepal.

BACKGROUND Choice of health-care services depends on patients' characteristics and the features of health-care facilities available. In Nepal, a significant proportion of health care is provided through the private sector, despite the introduction of free essential health care for all citizens in 2008. We sought to determine whether people chose private or public facilities in the first instance for acute health problems. We also assessed the reasons for their choice. MATERIALS AND METHODS A cross-sectional survey was done by use of a questionnaire administered to 400 household heads in Jhapa district, Nepal. RESULTS 272 (68%) respondents sought treatment from public health-care facilities in the first instance. On adjusted analysis, illiterate people were more likely to choose public facilities than people with higher secondary education (OR 5.47, P = 0.002). Similarly, lower-caste and religious-minority respondents were more likely to choose public facilities than disadvantaged janajati (OR 2.33, P = 0.01). Among respondents who used public facilities, 174 (64.0%) and 109 (40.0%) stated that that their choice was based on financial accessibility and physical accessibility, respectively. Among respondents who used private facilities, 65 (50.7%) and 54 (42.1%) said their choice was based on adequacy of resources/services and health-care delivery, respectively. CONCLUSION A substantial portion of respondents used public health-care facilities in the first instance, mainly because of financial and physical accessibility rather than adequacy of resources or better health-care delivery. These results may indicate a positive impact of removal of user fees for public health-care facilities in Nepal, especially for impoverished people.