Monetary factors include direct costs as well as indirect costs. These latter include the time it takes to get to the chosen treatment provider and the time one has to wait before seeing the provider. The rural people would, if their symptoms were not too serious, normally start with self-medication. They would purchase the drug in a grocery shop as a first therapy choice. Such a shop is easy to get to and there are no special opening hours which have to be kept. In such a shop one can also purchase one pill or one capsule at a time for as little as 1 or 2 Baht. This is of course important for people who do not have a lot of cash.
If the shop medicine did not help, the typical rural patient would proceed to the village health centre which is also within easy reach for all the people in Ban. Very old people, children under seven and very poor people are entitled to free drugs. All others have to pay for the drugs, often a set fee of 20 baht. As can be seen from table 4, the majority of patients went to the health centre as their first treatment choice. The reasons for this are varied. Many people come because they like the midwife (Noi). The health centre is also able to administer injections, something which is not part of self-medication practices in Thailand. Finally, some of the patients who went to the health centre probably evaluated their symptoms as serious enough to require professional attention.
Persistent illnesses would be brought either to the hospital in the district town of Ban Phang or to a private doctor’s clinic in the same town. Most people would try to get a ride with somebody going to Ban Phang to sell cassava or for other purposes. Otherwise a bus could be taken for a small fee but this would be quite time-consuming. So would waiting at the district hospital for that matter so it really had to be quite serious for people to choose this option. The rules for fee paying in the hospital are the same as in the health centre. But a private clinic would normally charge between 40 and 100 baht
Only rarely would a rural patient venture into the provincial hospital 50 km away. A visit to Udon Thani general hospital would be costly in terms of transportation, expenditures on food, time lost etc. In addition, few Thais would undertake such a hospital visit without being accompanied by a relative, so the cost of the trip would in fact be double.
In the research, no urban slum people visited more than one provider. This provider was most often a local grocery shop, a drug store/pharmacy or a private clinic in Udon Thani city. All of these were in walking distance although most people would buy when they went to work or hitch a ride with a samroi driver going into town.
Few of the people who had “poor-cards” entitling them to free treatment at the public hospital, used these rights. People explained that they did not have the time to wait their turn at the hospital. Personal observation at the outpatient department at Udon Hospital confirms that the average waiting time often was 2-3 hours. Most slum people have temporary manual jobs with very low salaries. This means that they cannot afford to lose a day’s income nor dare they be absent from work for hours at a time or they might be fired. This also means that relatives and friends in the slum rarely have time to accompany the patient to the hospital.
It seems ironic that the poorest people, namely the people in the slum area, are the people who use the public health facilities the least. As can be seem from the above, other factors such as work patterns and limited social relationships are more important in determining treatment seeking strategies than direct costs of services.