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Density versus Quality in Health Care Provision: Using Household Data to Make Budgetary Choices in Ethiopia

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  • Paul Collier
  • Stefan Dercon
  • John Mackinnon

Abstract

Usage of health facilities in Ethiopia is among the lowest in the world; raising usage rates is probably critical for improving health outcomes. The government has diagnosed the principal problem as the lack of primary health facilities and is devoting a large share of the health budget to building more facilities. But household data suggest that usage of health facilities is sensitive not just to the distance to the nearest facility but also to the quality of health care provided. If the quality of weak facilities were raised to the quality currently provided by the majority of facilities in Ethiopia, usage would rise significantly. National data suggest that, given the current density and quality of service provision, additional expenditure on improving the quality of service delivery will be more cost effective than increasing the density of service provision. The budget allocation rule presented in the article can help local policymakers make decisions about how to allocate funds between improving the quality of care and decreasing the distance to the nearest health care facility.

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Bibliographic Info

Paper provided by University of Oxford, Department of Economics in its series Economics Series Working Papers with number WPS/2002-17.

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Date of creation: 01 Sep 2002
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Handle: RePEc:oxf:wpaper:wps/2002-17

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  1. Alderman, Harold & Lavy, Victor, 1996. "Household Responses to Public Health Services: Cost and Quality Tradeoffs," World Bank Research Observer, World Bank Group, vol. 11(1), pages 3-22, February.
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  5. Lavy, Victor & Strauss, John & Thomas, Duncan & de Vreyer, Philippe, 1996. "Quality of health care, survival and health outcomes in Ghana," Journal of Health Economics, Elsevier, vol. 15(3), pages 333-357, June.
  6. Akin, John S. & Guilkey, David K. & Hazel?Denton, E., 1995. "Quality of services and demand for health care in Nigeria: A multinomial probit estimation," Social Science & Medicine, Elsevier, vol. 40(11), pages 1527-1537, June.
  7. Akin, John S, et al, 1986. "The Demand for Primary Health Care Services in the Bicol Region of the Philippines," Economic Development and Cultural Change, University of Chicago Press, vol. 34(4), pages 755-82, July.
  8. Appleton, Simon, 1998. "The Impact of Public Services on Health Care and Illness: A Treatment Effects Model with Sample Selectivity," Journal of African Economies, Centre for the Study of African Economies (CSAE), vol. 7(1), pages 1-33, March.
  9. Behrman, Jere R. & Deolalikar, Anil B., 1988. "Health and nutrition," Handbook of Development Economics, in: Hollis Chenery & T.N. Srinivasan (ed.), Handbook of Development Economics, edition 1, volume 1, chapter 14, pages 631-711 Elsevier.
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Cited by:
  1. Martine Visser & Frikkie Booysen, 2004. "Determinants of the choice of health care facility utilised by individuals in HIV/AIDS-affected households in the Free State province of South Africa," SALDRU/CSSR Working Papers 087, Southern Africa Labour and Development Research Unit, University of Cape Town.
  2. Das, Jishnu & Hammer, Jeffrey, 2007. "Money for nothing: The dire straits of medical practice in Delhi, India," Journal of Development Economics, Elsevier, vol. 83(1), pages 1-36, May.
  3. Paternostro, Stefano & Rajaram, Anand & Tiongson, Erwin R., 2005. "How does the composition of public spending matter?," Policy Research Working Paper Series 3555, The World Bank.
  4. Das, Jishnu & Hammer, Jeffrey, 2004. "Strained mercy : The quality of medical care in Delhi," Policy Research Working Paper Series 3228, The World Bank.
  5. Leonard, Kenneth L., 2009. "The cost of imperfect agency in health care: Evidence from rural Cameroun," Journal of Development Economics, Elsevier, vol. 88(2), pages 282-291, March.
  6. Heather Klemick & Kenneth L. Leonard & Melkiory C. Masatu, 2007. "Defining Access to Health Care: Evidence on the Importance of Quality and Distance in Rural Tanzania," American Journal of Agricultural Economics, Agricultural and Applied Economics Association, vol. 91(2), pages 347-358.
  7. Kumar, Santosh & Dansereau, Emily & Murray, Chris, 2012. "Does Distance matter for Institutional Delivery in Rural India? An Instrumental Variable Approach," MPRA Paper 45762, University Library of Munich, Germany, revised 01 Jan 2013.
  8. 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.
  9. Mogues, Tewodaj & Ayele, Gezahegne & Paulos, Zelekawork & Fan, Shenggen, 2006. "How Effective is Public Spending? Public Investment Composition and Rural Welfare in Ethiopia," 2006 Annual meeting, July 23-26, Long Beach, CA 21258, American Agricultural Economics Association (New Name 2008: Agricultural and Applied Economics Association).
  10. Hengjin Dong & Adjima Gbangou & Manuela Allegri & Subhash Pokhrel & Rainer Sauerborn, 2008. "The differences in characteristics between health-care users and non-users: implication for introducing community-based health insurance in Burkina Faso," The European Journal of Health Economics, Springer, vol. 9(1), pages 41-50, February.
  11. Benin, Samuel & Mogues, Tewodaj & Cudjoe, Godsway & Randriamamonjy, Josee, 2009. "Public expenditures and agricultural productivity growth in Ghana," 2009 Conference, August 16-22, 2009, Beijing, China 51634, International Association of Agricultural Economists.

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