Correlates of self-rated health status in the context of Sri Lanka

Sri Lanka owing to its high levels of achievements in arena of social indicators such as life expectancy, infant mortality rate or school enrollment rate relative to its income levels poses a paradox in the developing world. There is however near non-existent research examining correlates of self-rated health status in Sri Lanka. Self-rated health status has been accepted as a valid predictor of physical well- being and mortality. Present study, by investigating relative roles of demographic and socioeconomic characteristics, health care utilization pattern and level of satisfaction with the health care services in predicting self-rated health status in Sri Lanka, contributes to the growing literature on assessing subjective health measures in the context of developing countries. The analyses employ World Health Survey (WHS) data collected and disseminated by the World Health Organisation (WHO). The WHS was conducted in 2002-2003 for 69 countries and the data for the various countries was made available at varying points after the year 2006. The dependent variable, self–rated health status is a three pronged categorical variable, ‘very good/good’, ‘moderate’, ‘bad/very bad’. The independent variables are measures of demographic characteristics, socioeconomic status, health service utilization and level of satisfaction with health care services. The multivariate regression model employs the ordinal logistic technique and is estimated using maximum likelihood. Findings suggest that while ‘traditional’ factors like age, gender, education are important, access to modern types of cooking fuel and level of satisfaction with the health care system are significant. With respect to educational attainment, the greatest change in self-rated health status occurs when educational status changes from ‘primary school not completed’ to ‘primary school completed’. Also, individuals who utilized health services most recently are more likely to perceive their health as ‘moderate’ or ‘bad/very bad’ relative to ‘very good/good’ implying a correlation between objective and subjective health assessments. Further, estimates indicate that independent variables are more significantly associated with the change between self-rated health status categories of ‘moderate’ versus ‘good/very good’ status rather than between ‘very bad/bad’ versus ‘moderate’. Programs encouraging people to complete primary schooling, improve access to modern types of fuel and enhance quality of health care system will help in improving levels of self-rated health status.