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Bypassing Health Centres in Tanzania: Revealed Preferences for Quality

Author

Listed:
  • Kenneth L. Leonard
  • Gilbert R. Mliga
  • Damen Haile Mariam

Abstract

When patients bypass one health facility to seek care at another, strong preferences are revealed. The patterns of bypassing observed in Iringa Rural district in Tanzania show evidence of patients' understanding of various measures of quality at the facilities that they visit and bypass. We match two data sets that measured quality in health facilities with a sample of patient choice of health facilities. We use a conditional logit regression on patient choice of provider to show the relationship between patient behaviour and objective measures of technical quality in the health facilities. The paper shows that patients seek facilities that provide high quality consultations and prescriptions, are staffed by more knowledgeable physicians, and are better stocked with basic supplies. Patients avoid facilities that use injections too liberally or over-prescribe medication. Furthermore, the patterns differ significantly by illness condition and show evidence that patients understand the relative importance of these qualities for the condition from which they suffer. Copyright 2002, Oxford University Press.

Suggested Citation

  • Kenneth L. Leonard & Gilbert R. Mliga & Damen Haile Mariam, 2002. "Bypassing Health Centres in Tanzania: Revealed Preferences for Quality," Journal of African Economies, Centre for the Study of African Economies (CSAE), vol. 11(4), pages 441-471, December.
  • Handle: RePEc:oup:jafrec:v:11:y:2002:i:4:p:441-471
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    Citations

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    Cited by:

    1. Mæstad, Ottar & Torsvik, Gaute & Aakvik, Arild, 2009. "Overworked? The relationship between workload and health worker performance in rural Tanzania," Working Papers in Economics 02/09, University of Bergen, Department of Economics.
    2. World Bank, 2007. "India - Rural governments and Service Delivery : Volume 2. Note," World Bank Other Operational Studies 8008, The World Bank.
    3. Mæstad, Ottar & Torsvik, Gaute & Aakvik, Arild, 2010. "Overworked? On the relationship between workload and health worker performance," Journal of Health Economics, Elsevier, vol. 29(5), pages 686-698, September.
    4. Anja Sautmann & Samuel Brown & Mark Dean, 2016. "Subsidies, Information, and the Timing of Children's Health Care in Mali," CESifo Working Paper Series 6057, CESifo Group Munich.
    5. Magnus Lindelow, 2004. "Understanding spatial variation in the utilization of health," Development and Comp Systems 0409058, EconWPA.
    6. World Bank, 2007. "India - Rural Governments and Service Delivery : Volume 3. Main Report," World Bank Other Operational Studies 8009, The World Bank.
    7. Ikuo Ishibashi & Noriaki Matsushima, 2012. "Should Public Sectors Be Complements of Private Sectors?," Journal of Institutional and Theoretical Economics (JITE), Mohr Siebeck, Tübingen, vol. 168(4), pages 712-730, December.
    8. Jeuland, Marc & Lucas, Marcelino & Clemens, John & Whittington, Dale, 2010. "Estimating the private benefits of vaccination against cholera in Beira, Mozambique: A travel cost approach," Journal of Development Economics, Elsevier, vol. 91(2), pages 310-322, March.
    9. Van Rijsbergen, Bart & D’Exelle, Ben, 2013. "Delivery Care in Tanzania: A Comparative Analysis of Use and Preferences," World Development, Elsevier, vol. 43(C), pages 276-287.
    10. Gauthier, Bernard & Wane, Waly, 2011. "Bypassing health providers: The quest for better price and quality of health care in Chad," Social Science & Medicine, Elsevier, vol. 73(4), pages 540-549, August.
    11. Kruk, Margaret E. & Rockers, Peter C. & Mbaruku, Godfrey & Paczkowski, Magdalena M. & Galea, Sandro, 2010. "Community and health system factors associated with facility delivery in rural Tanzania: A multilevel analysis," Health Policy, Elsevier, vol. 97(2-3), pages 209-216, October.

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