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Quality of care and the demand for health services in Bamako, Mali: the specific roles of structural, process, and outcome components

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  • Mariko, Mamadou

Abstract

The public finance and foreign exchange crisis of the 1980s aggravated the unfavourable economic trends in many developing countries and resulted in budget cuts in the health sector. Policymakers, following the suggestions of World Bank experts, introduced user fees. Economic analysis of the demand for health care in these countries focused on the impact of price and income on health service utilisation. But the lesson to date from experiences in cost recovery is that without visible and fairly immediate improvements in the quality of care, the implementation of user fees will cause service utilisation to drop. For this reason, the role of quality of health care has been recently a subject of investigation in a number of health care demand studies. In spite of using the data from both households and facilities, recent studies are quite limited because they measure quality only by structural attributes (availability of drugs, equipment, number and qualifications of staff, and so on). Structural attributes of quality are necessary but not sufficient conditions for demand. A unique feature of this study is that it also considers the processes followed by practitioners and the outcome of care, to determine simultaneously the respective influence of price and quality on decision making. A nested multinomial logit was used to examine the choice between six alternatives (self-treatment, modern treatment at home, public hospital, public dispensary, for-profit facility and non-profit facility). The estimations are based on data from a statistically representative sample of 1104 patients from 1191 households and the data from a stratified random sample of 42 out of 84 facilities identified. The results indicate that omitting the process quality variables from the demand model produces a bias not only in the estimated coefficient of the "price" variable but also in coefficients of some structural attributes of the quality. The simulations suggest that price has a minor effect on utilisation of health services, and that health authorities can simultaneously double user fees and increase utilisation by emphasising improvement of both the structural and process quality of care in public health facilities.

Suggested Citation

  • 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, vol. 56(6), pages 1183-1196, March.
  • Handle: RePEc:eee:socmed:v:56:y:2003:i:6:p:1183-1196
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    Citations

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    Cited by:

    1. Martine AUDIBERT & Jean-Yves LE HESRAN & Stéphanie DOS SANTOS & Hervé LAFARGE & Richard LALOU & Georges Karna KONE, 2013. "Use of health care among the urban poor in Africa: Does the neighbourhood have an impact?," Working Papers 201319, CERDI.
    2. Jacky MATHONNAT & Yong HE & Martine AUDIBERT, 2013. "Two-Period Comparison of Healthcare Demand with Income Growth and Population Aging in Rural China: Implications for Adjustment of the Healthcare Supply and Development," Working Papers 201315, CERDI.
    3. Anna S. Brink & Steven F. Koch, 2013. "The 1996 User Fee Abolition in South Africa: A Difference-in-Difference Analysis," Working Papers 201332, University of Pretoria, Department of Economics.
    4. Trani, Jean-Francois & Bakhshi, Parul & Noor, Ayan A. & Lopez, Dominique & Mashkoor, Ashraf, 2010. "Poverty, vulnerability, and provision of healthcare in Afghanistan," Social Science & Medicine, Elsevier, vol. 70(11), pages 1745-1755, June.
    5. Martine AUDIBERT & Jacky MATHONNAT & Yong HE, 2010. "Income Growth, Price Variation and Health Care Demand: A Mixed Logit Model Applied to Tow-period Comparison in Rural China," Working Papers 201035, CERDI.
    6. Magnus Lindelow, 2003. "Understanding spatial variation in the utilization of health services: does quality matter?," Economics Series Working Papers WPS/2004-12, University of Oxford, Department of Economics.
    7. Mataria, Awad & Donaldson, Cam & Luchini, Stephane & Moatti, Jean-Paul, 2004. "A stated preference approach to assessing health care-quality improvements in Palestine: from theoretical validity to policy implications," Journal of Health Economics, Elsevier, vol. 23(6), pages 1285-1311, November.
    8. Saturnin Bertrand Nguenda Anya & Atanase Yene, 2016. "The determinants of the choice of treatment of pregnant women in Cameroon," Health Economics Review, Springer, vol. 6(1), pages 1-9, December.
    9. Mataria, Awad & Giacaman, Rita & Khatib, Rana & Moatti, Jean-Paul, 2006. "Impoverishment and patients' "willingness" and "ability" to pay for improving the quality of health care in Palestine: An assessment using the contingent valuation method," Health Policy, Elsevier, vol. 75(3), pages 312-328, February.
    10. Geneau, Robert & Massae, Patrick & Courtright, Paul & Lewallen, Susan, 2008. "Using qualitative methods to understand the determinants of patients' willingness to pay for cataract surgery: A study in Tanzania," Social Science & Medicine, Elsevier, vol. 66(3), pages 558-568, February.
    11. Magnus Lindelow, 2004. "Understanding spatial variation in the utilization of health," Development and Comp Systems 0409058, EconWPA.
    12. Pokhrel, Subhash & De Allegri, Manuela & Gbangou, Adijma & Sauerborn, Rainer, 2010. "Illness reporting and demand for medical care in rural Burkina Faso," Social Science & Medicine, Elsevier, vol. 70(11), pages 1693-1700, June.
    13. Friend-du Preez, Natalie & Cameron, Noël & Griffiths, Paula, 2013. "“So they believe that if the baby is sick you must give drugs…” The importance of medicines in health-seeking behaviour for childhood illnesses in urban South Africa," Social Science & Medicine, Elsevier, vol. 92(C), pages 43-52.

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