ABSTRACT
The health care services in Jamaica are provided free or at a nominal charge to all citizens. Services range form a broad primary health care network to sophisticated tertiary care, and most Jamaicans have relatively easy access to all levels of health care service. A survey was conducted by means of a questionaire on a sample of 130 clients selected from the primary (Department of Social Preventive Medicine) and tertiary health care facilities (A/E UHWI) during February and March, 1996. Factors influencing client's choice were analyzed to determine reasons for bypassing the primary care facility resulting in the inefficient use of more specialized resources at the tertiary level. The results revealed that clients visiting the primary care facility (DSPM) resided within an estimated mean distance of 1.7 miles from the clinic and 4.3 miles from the tertiary care facility (A/E - UHWI). With respect to the distance travelled, transportation costs and time, the tertiary care facility (A/E -UHWI) was less accessible. The majority (94 percent) of clients visiting the primary facility, were able to commute within less than half an hour to access care at this facility. Also, those commuting paid less in transportation cost than those who visited the tertiary facility. Females were significantly (p<0.01) more likely to visit both health facilities than males. However in the 5 pm - 8 am and weekend time frames at the tertiary level, males out numbered the females 60 to 40 per cent. The majority of clients visiting both health facilities were in the under 20 and 20 - 39 age group. In terms of the clients' health seeking behaviour, 71 and 51 per cent utilized the primary and tertiary health care facilities respectively, as a first option for health care. Self referrals accounted for the highest percentage (60 percent) of all sources to the tertiary facility (A/E - UHWI). Of this total, 68 per cent was during the 5 pm - 8 am and weekend time frames. It was the finding also that the estimated waiting time for a doctors' consult was 55 minutes on average at the primary facility (DSPM) than the tertiary (A/E - UHWI). There were no significant differences in the level of satisfaction of the services received by clients visiting facilities. However 62 per cent were dissatisfied with the opening hours of the primary care facility. (AU)