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Defining Access to Health Care: Evidence on the Importance of Quality and Distance in Rural Tanzania

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Author Info
Klemick, Heather
Leonard, Kenneth L.
Masatu, Melkiory C.

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Abstract

We examine the implications of health seeking behavior on access to quality health care using a unique dataset that combines a household survey from rural Tanzania with the location and quality of all health facilities available to households. Patients do not always visit the nearest facility, but choose from among multiple facilities, improving the quality of care they receive by bypassing low quality facilities. Recognizing this behavior alters the projected benefits to health interventions, reducing the value of focusing on the staff qualifications and increasing the value of focusing on travel time and the motivation of current staff.

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Publisher Info
Paper provided by University of Maryland, Department of Agricultural and Resource Economics in its series Working Papers with number 6178.

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Date of creation: 2008
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Handle: RePEc:ags:umdrwp:6178

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Keywords: Community/Rural/Urban Development; Health Economics and Policy;

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  1. Paul Collier & Stefan Dercon & John Mackinnon, 2002. "Density versus Quality in Health Care Provision: Using Household Data to Make Budgetary Choices in Ethiopia," World Bank Economic Review, Oxford University Press, vol. 16(3), pages 425-448, December.
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  2. Das, Jishnu & Hammer, Jeffrey, 2004. "Which doctor? Combining vignettes and item response to measure doctor quality," Policy Research Working Paper Series 3301, The World Bank. [Downloadable!]
  3. Kenneth L. Leonard, 2007. "Learning in Health Care: Evidence of Learning about Clinician Quality in Tanzania," Economic Development and Cultural Change, University of Chicago Press, vol. 55, pages 531-555. [Downloadable!]
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  4. Kara Hanson & Winnie C. Yip & William Hsiao, 2004. "The impact of quality on the demand for outpatient services in Cyprus," Health Economics, John Wiley & Sons, Ltd., vol. 13(12), pages 1167-1180. [Downloadable!]
  5. Kenneth L. Leonard & Melkiory C. Masatu & Alexandre Vialou, 2007. "Getting Doctors to Do Their Best: The Roles of Ability and Motivation in Health Care Quality," Journal of Human Resources, University of Wisconsin Press, vol. 42(3). [Downloadable!] (restricted)
  6. Chomitz, Kenneth M. & Setiadi, Gunawan & Azwar, Azrul & Ismail, Nusye & Widiyarti, 1998. "What do doctors want? developing incentives for doctors to serve in Indonesia's rural and remote areas," Policy Research Working Paper Series 1888, The World Bank. [Downloadable!]
  7. Kenneth L. Leonard & Gilbert R. Mliga & Damien Haile Mariam, 2002. "Bypassing health centers in Tanzania: Revealed preferences for observable and unobservable quality," Discussion Papers 0102-43, Columbia University, Department of Economics. [Downloadable!]
  8. Fan, Shenggen & Chan-Kang, Connie, 2005. "Road development, economic growth, and poverty reduction in China:," Research reports 138, International Food Policy Research Institute (IFPRI). [Downloadable!]
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  9. Jishnu Das & Jeffrey Hammer & Kenneth Leonard, 2008. "The Quality of Medical Advice in Low-Income Countries," Journal of Economic Perspectives, American Economic Association, vol. 22(2), pages 93-114, Spring.
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  10. Leonard, Kenneth L., 2003. "African traditional healers and outcome-contingent contracts in health care," Journal of Development Economics, Elsevier, vol. 71(1), pages 1-22, June. [Downloadable!] (restricted)
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  11. Leonard, Kenneth L., 2002. "When both states and markets fail: asymmetric information and the role of NGOs in African health care," International Review of Law and Economics, Elsevier, vol. 22(1), pages 61-80, July. [Downloadable!] (restricted)
  12. Jean-Philippe Platteau, 1996. "Physical infrastructure as a constraint on agricultural growth: The case of sub-Saharan Africa," Oxford Development Studies, Taylor and Francis Journals, vol. 24(3), pages 189-219. [Downloadable!] (restricted)
  13. Das, Jishnu & Hammer, Jeffrey, 2005. "Money for nothing : the dire straits of medical practice in Delhi, India," Policy Research Working Paper Series 3669, The World Bank. [Downloadable!]
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  14. Chaudhury, Nazmul & Hammer, Jeffrey S., 2003. "Ghost doctors - absenteeism in Bangladeshi health facilities," Policy Research Working Paper Series 3065, The World Bank. [Downloadable!]
  15. Filmer, Deon & Hammer, Jeffrey S & Pritchett, Lant H, 2000. "Weak Links in the Chain: A Diagnosis of Health Policy in Poor Countries," World Bank Research Observer, Oxford University Press, vol. 15(2), pages 199-224, August.
  16. Fan, Shenggen & Hazell, Peter & Thorat, Sukhadeo, 2000. " Government Spending, Growth and Poverty in Rural India," American Journal of Agricultural Economics, American Agricultural Economics Association, vol. 82(4), pages 1038-51, November. [Downloadable!] (restricted)
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