Understanding spatial variation in the utilization of health services: does quality matter?
AbstractUtilization of health services are an important policy concern in most developing countries, reflecting both efforts to improve health outcomes and to meet international obligations to make health services broadly accessible. Although many policy and research initiatives have focused on the need to improve physical access, not enough is understood about what factors affect health care choices, and why low levels of utilization persists among certain socioeconomic groups or geographic regions despite improved physical access. Reflecting these concerns, this paper focuses on the role of health care quality in understanding spatial variation in the utilization of both curative and preventive health services in Mozambique. The analysis is based on matched household and facility data, where the sample of household was drawn from the catchment area of each facility. The findings show that health care quality is a significant and important factor in women`s choice of delivery location. In particular, both the presence of maternity staff and a broader service range make it more likely that women choose a facility-based delivery. Conversely, the analysis suggests that quality is not a significant determinant in decisions about outpatient visits, while physical access, education, and economic variables are important. The findings hence suggest that the impact of quality may be service specific, and that although certain dimensions of quality may have little or no impact on outpatient visits, they may be important determinants of the use of other health services. As developing countries to continue to face difficult trade-offs between quality and physical access in the allocation of resources, it will be important to deepen our understanding of how individuals make health care choices. The results presented in this paper are a step in that direction.
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Date of creation: 01 Dec 2003
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- Gertler, Paul & Locay, Luis & Sanderson, Warren, 1987.
"Are user fees regressive? : The welfare implications of health care financing proposals in Peru,"
Journal of Econometrics, Elsevier,
Elsevier, vol. 36(1-2), pages 67-88.
- Paul J. Gertler & Luis Locay & Warren C. Sanderson, 1987. "Are User Fees Regressive? The Welfare Implications of Health Care Financing Proposals in Peru," NBER Working Papers 2299, National Bureau of Economic Research, Inc.
- Gertler, Paul J & Waldman, Donald M, 1992. "Quality-Adjusted Cost Functions and Policy Evaluation in the Nursing Home Industry," Journal of Political Economy, University of Chicago Press, University of Chicago Press, vol. 100(6), pages 1232-56, December.
- Lavy, Victor & Quigley, John M., 1991.
"Willingness to Pay for the Quality and Intensity of Medical Care: Evidence from Low Income Households in Ghana,"
Department of Economics, Working Paper Series, Department of Economics, Institute for Business and Economic Research, UC Berkeley
qt4p02g6nq, Department of Economics, Institute for Business and Economic Research, UC Berkeley.
- Victor Lavy and John M. Quigley., 1991. "Willingness to Pay for the Quality and Intensity of Medical Care: Evidence from Low Income Households in Ghana," Economics Working Papers, University of California at Berkeley 91-178, University of California at Berkeley.
- Lavy, Victor & Quigley, John M., 1991. "Willingness to Pay For the Quality and Intensity of Medical Care: Evidence from Low Income Households in Ghana," Berkeley Program on Housing and Urban Policy, Working Paper Series, Berkeley Program on Housing and Urban Policy qt8237c6g3, Berkeley Program on Housing and Urban Policy.
- John S. Akin & David K. Guilkey & Paul L. Hutchinson & Michael T. Mcintosh, 1998. "Price elasticities of demand for curative health care with control for sample selectivity on endogenous illness: an analysis for Sri Lanka," Health Economics, John Wiley & Sons, Ltd., vol. 7(6), pages 509-531.
- 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, Elsevier, vol. 40(11), pages 1527-1537, June.
- 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.
- Lavy, V & Strauss, J & Thomas, D & de Vreyer, P, 1996.
"Quality of Health Care, Survivial and Health Outcomes in Ghana,"
Papers, RAND - Reprint Series
96-20, RAND - Reprint Series.
- 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, Elsevier, vol. 15(3), pages 333-357, June.
- Jowett, Matthew, 2000. "Safe motherhood interventions in low-income countries: an economic justification and evidence of cost effectiveness," Health Policy, Elsevier, Elsevier, vol. 53(3), pages 201-228, October.
- Schwartz, J Brad & Akin, John S & Popkin, Barry M, 1988. "Price and Income Elasticities of Demand for Modern Health Care: The Case of Infant Delivery in the Philippines," World Bank Economic Review, World Bank Group, World Bank Group, vol. 2(1), pages 49-76, January.
- Williams, Brian & Coyle, Joanne & Healy, David, 1998. "The meaning of patient satisfaction: An explanation of high reported levels," Social Science & Medicine, Elsevier, Elsevier, vol. 47(9), pages 1351-1359, November.
- Mariko, Mamadou, 2003. "Quality of care and the demand for health services in Bamako, Mali: the specific roles of structural, process, and outcome components," Social Science & Medicine, Elsevier, Elsevier, vol. 56(6), pages 1183-1196, March.
- Germano Mwabu & Martha Ainsworth & Andrew Nyamete, 1993. "Quality of Medical Care and Choice of Medical Treatment in Kenya: An Empirical Analysis," Journal of Human Resources, University of Wisconsin Press, vol. 28(4), pages 838-862.
- De Geyndt, W., 1995. "Managing the Quality of Health Care in Developing Countries," Papers, World Bank - Technical Papers 258, World Bank - Technical Papers.
- Weisbrod, Burton A, 1991. "The Health Care Quadrilemma: An Essay on Technological Change, Insurance, Quality of Care, and Cost Containment," Journal of Economic Literature, American Economic Association, vol. 29(2), pages 523-52, June.
- Alderman, Harold & Lavy, Victor, 1996. "Household Responses to Public Health Services: Cost and Quality Tradeoffs," World Bank Research Observer, World Bank Group, World Bank Group, vol. 11(1), pages 3-22, February.
- Thomas Mroz & Kenneth Bollen & Ilene Speizer & Dominic Mancini, 1999. "Quality, accessibility, and contraceptive use in rural tanzania," Demography, Springer, Springer, vol. 36(1), pages 23-40, February.
- Gilson, Lucy & Kitange, Henry & Teuscher, Thomas, 1993. "Assessment of process quality in Tanzanian primary care," Health Policy, Elsevier, Elsevier, vol. 26(2), pages 119-139, December.
- Mwabu, Germano M., 1986. "Health care decisions at the household level: Results of a rural health survey in Kenya," Social Science & Medicine, Elsevier, Elsevier, vol. 22(3), pages 315-319, January.
- Peabody, John W. & Gertler, Paul J. & Leibowitz, Arleen, 1998. "The policy implications of better structure and process on birth outcomes in Jamaica," Health Policy, Elsevier, Elsevier, vol. 43(1), pages 1-13, January.
- Campbell, S. M. & Roland, M. O. & Buetow, S. A., 2000. "Defining quality of care," Social Science & Medicine, Elsevier, Elsevier, vol. 51(11), pages 1611-1625, December.
- Annandale, Ellen & Hunt, Kate, 1998. "Accounts of disagreements with doctors," Social Science & Medicine, Elsevier, Elsevier, vol. 46(1), pages 119-129, January.
- Feyisetan, Bamikale J & Ainsworth, Martha, 1996. "Contraceptive Use and the Quality, Price, and Availability of Family Planning in Nigeria," World Bank Economic Review, World Bank Group, World Bank Group, vol. 10(1), pages 159-87, January.
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