Investigator(s)
| Submitter |
Sonam Phuntsho Planning Unit, KGUMSB Sonam Phuntsho 
|
| Principal Investigator |
Chantal Herberholz Centre of Excellence for Health Economics, Faculty of Economics, Chulalongkorn University, Thailand, Chantal Herberholz
|
| Co-Investigator(s) |
Sonam Phuntsho Planning Unit, KGUMSB Sonam Phuntsho
|
Title(s) and abstract
| Scientific title | Geographic variations in healthcare utilization: Cross-sectional evidence from the 2022 Bhutan Living Standard Survey |
| Public title | Geographic variations in healthcare utilization: Cross-sectional evidence from the 2022 Bhutan Living Standard Survey |
| Background | Variations in healthcare utilization across geographic dimensions such as rural and urban areas, districts, and regions hinder progress towards achieving and sustaining universal health coverage. Studies comparing rural and urban healthcare utilization consistently identify significant disparities, especially for elderly population groups (Doan & Giang, 2025; Martinho & Leite, 2025; Mulyanto et al., 2019). Differences in healthcare utilization across geographic areas are determined by individual-level factors such as demographic and socioeconomic factors and factors associated with specific locations, including for instance distance to healthcare facilities and population density (Misra et al., 2025; Mulyanto et al., 2019). Geographic variations in healthcare utilization are also affected by public health emergencies (Islam et al., 2024; Oduro et al., 2023; Xiao et al., 2021). In China, for example, healthcare utilization declined after the COVID-19 outbreak, with decreases more pronounced in developed than in developing regions (Xiao et al., 2021). Given Bhutan’s unique remote geography, several studies analyze healthcare utilization in Bhutan. Damrongplasit and Wangdi (2017) and Herberholz and Phuntsho (2018) show that the probability of seeking formal care when ill or injured is lower for those living in remote areas, as measured by distance-based indicators, and those who seek care are less likely to receive services from secondary or tertiary facilities. Similarly, Sharma et al. (2024) reports that the odds of using primary health centers compared to outpatient hospital care is higher for those living in rural areas. While the former two studies use binary logit and multinomial regression analyses, the latter employs decomposition analysis. All three studies draw on data from earlier Bhutan Living Standard Survey waves, conducted before the coronavirus pandemic. |
| Objectives | To explore geographic differences in healthcare utilization in Bhutan, this study builds on the approach in Mulyanto et al. (2019) and employs geographic variables as main predictors in logistic regression models |
| Study Methods | Data This study uses data from the 2022 Bhutan Living Standard Survey, a cross-sectional, nationally representative dataset. The 2022 wave was collected between April and June and in some places in July and August . Data on population density, on the other hand, are from City Population (Brinkhoff, 2022). Outcome variable The 2022 Bhutan Living Standard Survey questionnaire asks respondents if they suffered from any sickness or injury in the last 12 months and if they visited a healthcare facility as outpatient or inpatient in case of sickness or injury. The sample used in this study only comprises those respondents who reported sickness or injury in the past 12 months. Unlike in previous waves, the dataset does not contain any information about the number of visits or the type of facility visited. Three alternative dependent variables are created that capture if the respondent utilized outpatient services (y_1), inpatient services (y_2), or no healthcare services (y_3) when sick or injured over the recall period. |
| Expected outcomes and use of results | Controls Healthcare utilization is influenced by predisposing, enabling and need factors (Andersen, 1995). The selected variables, therefore, are age, sex, marital status, level of education, and per capita household expenditure. Since the survey did not ask about health status, age and sex are also considered need variables. |
| Keywords | Healthcare Utilisation, Equity, Access, Bhutan |
Research Details
| Student research | No |
| Start Date | 01-Feb-2026 |
| End Date | 31-May-2026 |
| Key Implementing Institution | none |
| Multi-country research | No |
| Nationwide research | Yes |
| Research Domain(s) | Non-communicable diseases & Healthy Lifestyles |
| Research field(s) | Health Care Seeking/Utilization |
| Involves human subjects | Yes |
| Population-Based Survey | |
| Data Collection | Secondary data |
| Proposal reviewed by other Committee | No |