In developing countries, where an individual’s financial resources are often scarce, health care utilization is not always the highest priority, and even when ill an individual may choose not to seek health care
]. Without taking economic and social conditions into account there are three main health care scenarios: First, if there is a surplus of professional medical services compared with medical needs, the growth rate of professional medical services use should be faster than that of self-treatment. Second, if there is a relative supply and demand balance, the growth rate of both will remain at a steady level. Third, if there is a gap in professional medical services, the self-treatment growth rate may be faster. According to our findings, China fits into the third scenario. We can conclude that China's self-treatment and professional medical services have shared the incremental medical needs of residents in recent years. Should all those that use self-treatment shift to using professional medical services, the medical institutions would not be able to cope. Therefore, at this stage self-treatment should be an important supplemental channel to professional medical services.
Our study revealed that the prevalence of self-treatment with a recall period of two-weeks significantly differed in urban and rural population (31.2% vs 14.9% in 1993, 43.5% vs 21.4% in 1998, 47.2% vs 31.4% in 2003, 31.0% vs 25.3% in 2008) in China. Similar results were reported by other studies. A study in Portugal reported an urban (26.2%) - rural (21.5%) difference in self-treatment
]. In India, self-treatment prevalence was 37% in urban and 17% in rural population
]. It is difficult to compare with other studies in the prevalence of self-treatment due to the use of different definitions of self-treatment.
In the analysis of individual health care decision-making, we found that self-perceived illness status, economic condition, and individual health-behavior were important factors. These individual factors construct an internal-dynamic mechanism of self-treatment selection. The effect of different illness symptoms (severity, duration) on the probability to self-treat shows a certain degree of rationality. However, educational and economic variables also seem to have persuasive effects on health care choices. With increasing education and income the probability of self-treatment also increases. Some scholars consider that self-treatment is an economic-restraint phenomenon
], and that the proportion of highly educated individuals who use self-treatment should decrease because they may have gained a higher income than others. The profession, TV, and sanitary water associations we found support this hypothesis. This finding of an economic relationship with the use of self-treatment is an important consideration when rethinking health care in China. Gender and marriage had no impact on the decision to self-treat, in accordance with Hjortsberg’s study
Drug accessibility is also an important determinant of the use of self-treatment. Pharmacies are included in the CNHS in the assessment of distances from medical institutions. In recent years, the accessibility of pharmacies has substantially increased in rural and urban areas because the Chinese Government has implemented the construction of a drug sales network
].We found that living in an urban area increased the likelihood to self-treat. This may be because urban infrastructure is superior to that of rural areas. The use of self-treatment is relative to price and time costs. It has been found that urban residents are likely to choose cheap, easy self-treatments when their illness symptoms are minor, common and just beginning
]. The switch of prescription to OTC drugs has been deregulated in China, and like as Hubertus Cranz, the Association of the European Self-Medication Industry (AESGP) director general said, taking into account the growing recognition of the economic and public health value of self-medication, many opportunities lie ahead of us
Insurance is a system factor related to the use of self-treatment. Most other medical insurance and rural cooperative medical schemes have been based on inpatient or serious-illness accounts; but urban basic medical insurance and free medical insurance have been based on both outpatient and inpatient accounts. Those who have the former insurance will not be reimbursed for the drugs acquired as an outpatient, while those who have the latter insurance can be reimbursed for such drugs once every quarter or year
]. Therefore, insurance status has a significant impact on the choice of using public village clinics relative to self-treatment
]. At present, China is implementing the New Cooperative Medical Scheme (NCMS) and urban basic medical insurance system to achieve universal medical insurance coverage. We believe that this will have a significant impact on self-treatment.
There are two major limitations to this study. A major limitation is that cross-sectional study does not establish cause-effect relationship between factors and self-treatment, even after controlling for potential confounders. A second limitation is that it is difficult to compare with other studies due to the inconsistencies of definitions of self-treatment. Owing to time constraints, we did not conduct in-depth interviews with self-treatment stakeholders regarding its development. Meanwhile, relevant research in China is lacking, especially analyses of the CNHS data. Therefore, it is difficult to provide a context for our results. This study is only a preliminary characterization of self-treatment in China. The next step is to focus on self-treatment among the elderly, women and children, and those with chronic diseases.