Dissertation (Doctoral) Patterns, Determinants and Spatial Analysis of Health Service Utilization Following the 2004 Tsunami in Thailand


Wanrudee Isaranuwatchai


On December 26th, 2004, 280,000 people lost their lives. A massive earthquake struck Indonesia, triggering a tsunami that affected several countries, including Thailand. The disaster had important implications for health status of Thai citizens, as well as health system planning, and thus underscores the need to study its long-term effect. This dissertation examined the patterns, determinants, and spatial analysis of health service utilization following the tsunami in Thailand. The primary aim was to determine whether tsunami-affected status (personal injury or property loss) and distance to a health facility (public health center or hospital) influenced health service utilization.

The study population included Thai citizens (aged 14+), living in the tsunami-affected Thai provinces: Phuket, Phang Nga, Krabi, and Ranong. Study participants were randomly selected from the ‘affected’ and ‘unaffected’ populations. One and two years after the tsunami, participants were interviewed in-person on demographic and socio-economic factors, disaster impact, health status, and health service utilization. Five types of health services were examined: outpatient services, inpatient services, home visits, medications, and informal (unpaid) care. Distance to a health facility was calculated using Geographic Information System's Network Analyst. The Grossman model of the demand for health care and a distance decay concept provided the foundation for this study. A propensity score method and a two-part model were used to examine the study objectives.

There were 1,889 participants. One year after the tsunami, individuals affected by property loss were more likely to use medications than unaffected participants. Two years after the tsunami, individuals with personal injury were more likely to use outpatient services, medications, and informal care than unaffected participants. Distance to a health facility was associated with the use of medications and informal care.

The results confirmed the long-term effect of a tsunami. This dissertation may assist the decision- and policy-makers in the identification of those most likely to use health services and in the request of health resources to the affected areas. The patterns, determinants, and spatial analysis of health service utilization found in this study may not be specific to a tsunami and may provide insights on post-disaster contexts of other natural disasters.


Peter C. Coyte