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

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Author Info
Paul Collier (Centre for the Study of African Economies)
Stefan Dercon (Centre for the Study of African Economies)
John Mackinnon

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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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Paper provided by EconWPA in its series Development and Comp Systems with number 0409052.

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Length: 43 pages
Date of creation: 28 Sep 2004
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Handle: RePEc:wpa:wuwpdc:0409052

Note: Type of Document - pdf; pages: 43
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Web page: http://129.3.20.41

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Find related papers by JEL classification:
I1 - Health, Education, and Welfare - - Health
H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
O12 - Economic Development, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development

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  1. 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. [Downloadable!] (restricted)
  2. Thomas, D & Lavy, V & Strauss, J, 1996. "Public Policy and Anthropometric Outcomes in the Cote d'Ivoire," Papers 96-19, RAND - Reprint Series.
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  3. Filmer, Deon & Hammer, Jeffrey & Pritchett, Lant, 1998. "Health policy in poor countries : weak links in the chain," Policy Research Working Paper Series 1874, The World Bank. [Downloadable!]
  4. 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.
  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. [Downloadable!] (restricted)
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  6. Alderman, Harold & Lavy, Victor, 1996. "Household Responses to Public Health Services: Cost and Quality Tradeoffs," World Bank Research Observer, Oxford University Press, vol. 11(1), pages 3-22, February.
  7. Appleton, Simon, 1998. "The Impact of Public Services on Health Care and Illness: A Treatment Effects Model with Sample Selectivity," Journal of African Economies, Oxford University Press, vol. 7(1), pages 1-33, March.
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(explanations, Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.)

  1. Klemick, Heather & Leonard, Kenneth L. & Masatu, Melkiory C., 2008. "Defining Access to Health Care: Evidence on the Importance of Quality and Distance in Rural Tanzania," Working Papers 6178, University of Maryland, Department of Agricultural and Resource Economics. [Downloadable!]
  2. Mogues, Tewodaj & Ayele, Gezagehn & 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). [Downloadable!]
  3. Das, Jishnu & Hammer, Jeffrey, 2004. "Strained mercy : The quality of medical care in Delhi," Policy Research Working Paper Series 3228, The World Bank. [Downloadable!]
  4. 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!]
  5. 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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  6. 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. [Downloadable!]
  7. 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. [Downloadable!] (restricted)
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