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

Author

Listed:
  • 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 that 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. Copyright 2002, Oxford University Press.

Suggested Citation

  • Paul Collier & Stefan Dercon & John Mackinnon, 2002. "Density versus Quality in Health Care Provision: Using Household Data to Make Budgetary Choices in Ethiopia," The World Bank Economic Review, World Bank, vol. 16(3), pages 425-448, December.
    • Handle: RePEc:oup:wbecrv:v:16:y:2002:i:3:p:425-448
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    Cited by:

    1. 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.
    2. Das, Jishnu & Hammer, Jeffrey, 2004. "Strained mercy : The quality of medical care in Delhi," Policy Research Working Paper Series 3228, The World Bank.
    3. 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.
    4. 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;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 9(1), pages 41-50, February.
    5. 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.
    6. Mogues, Tewodaj & Billings, Lucy, 2015. "The making of public investments: Champions, coordination, and characteristics of nutrition interventions," IFPRI discussion papers 1479, International Food Policy Research Institute (IFPRI).
    7. 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.
    8. Frikkie Booysen & Martine Visser, 2010. "Health Facility Choice In Hiv‐ And Aids‐Affected Households In Two South African Communities," South African Journal of Economics, Economic Society of South Africa, vol. 78(1), pages 89-106, March.
    9. 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.
    10. Mogues, Tewodaj & Billings, Lucy, 2019. "The making of public investments: The role of champions, co-ordination, and characteristics of nutrition programmes in Mozambique," Food Policy, Elsevier, vol. 83(C), pages 29-38.
    11. Laura Anselmi & Mylène Lagarde & Kara Hanson, 2015. "Health service availability and health seeking behaviour in resource poor settings: evidence from Mozambique," Health Economics Review, Springer, vol. 5(1), pages 1-13, December.
    12. 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.
    13. Santosh Kumar & Emily A. Dansereau & Christopher J. L. Murray, 2014. "Does distance matter for institutional delivery in rural India?," Applied Economics, Taylor & Francis Journals, vol. 46(33), pages 4091-4103, November.
    14. Mogues, Tewodaj & Ayele, Gezahegn & 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).
    15. Stefano Paternostro & Anand Rajaram & Erwin R. Tiongson, 2007. "How Does the Composition of Public Spending Matter?," Oxford Development Studies, Taylor & Francis Journals, vol. 35(1), pages 47-82.
    16. 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.
    17. Hamid R. Davoodi & Erwin R Tiongson & Sawitree Sachjapinan Asawanuchit, 2010. "Benefit Incidence of Public Education and Health Spending Worldwide: Evidence From A New Database," Poverty & Public Policy, John Wiley & Sons, vol. 2(2), pages 5-52, May.

    More about this item

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development

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