IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v12y2003i9p755-770.html
   My bibliography  Save this article

Why do the sick not utilise health care? The case of Zambia

Author

Listed:
  • Catharina Hjortsberg

Abstract

When ill the individual faces the options of seeking health care, using self‐medication or doing nothing. In an economic perspective, an individual's propensity to utilise health care is determined by the costs of utilisation and the perceived benefits of health care. The propensity to utilise health care may hence be expected to vary between individuals. In this paper we attempt on the one hand to determine what factors influence sick individuals' propensity to seek health care at a health facility or use self‐medication (or do nothing), and on the other hand attempt to determine the factors that influence the magnitude of their expenditures for health care, in particular what other factors than just health status influence utilisation. For the empirical analysis, data, covering 9700 individuals, from the 1998 Living Conditions Monitoring Survey (LCMS) is used. We use a Multinomial Logit selection model to estimate the equation, which allows us to analyse health‐care utilisation through two separate processes, the decision to seek care and the magnitude of expenditures incurred. In general, we find that the individuals are influenced by income, insurance, type of illness and access variables such as distance and owning a vehicle. Copyright © 2003 John Wiley & Sons, Ltd.

Suggested Citation

  • Catharina Hjortsberg, 2003. "Why do the sick not utilise health care? The case of Zambia," Health Economics, John Wiley & Sons, Ltd., vol. 12(9), pages 755-770, September.
    • Handle: RePEc:wly:hlthec:v:12:y:2003:i:9:p:755-770
    DOI: 10.1002/hec.839
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hec.839
    Download Restriction: no
    File URL: https://libkey.io/10.1002/hec.839?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-277, June.
    2. Bolin, Kristian & Jacobson, Lena & Lindgren, Bjorn, 2001. "The family as the health producer -- when spouses are Nash-bargainers," Journal of Health Economics, Elsevier, vol. 20(3), pages 349-362, May.
    3. Janet Currie & Jonathan Gruber, 1996. "Health Insurance Eligibility, Utilization of Medical Care, and Child Health," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 111(2), pages 431-466.
    4. Duncan Thomas, 1990. "Intra-Household Resource Allocation: An Inferential Approach," Journal of Human Resources, University of Wisconsin Press, vol. 25(4), pages 635-664.
    5. Acton, Jan Paul, 1975. "Nonmonetary Factors in the Demand for Medical Services: Some Empirical Evidence," Journal of Political Economy, University of Chicago Press, vol. 83(3), pages 595-614, June.
    6. Jacobson, Lena, 2000. "The family as producer of health -- an extended grossman model," Journal of Health Economics, Elsevier, vol. 19(5), pages 611-637, September.
    7. Kenkel, Donald S, 1991. "Health Behavior, Health Knowledge, and Schooling," Journal of Political Economy, University of Chicago Press, vol. 99(2), pages 287-305, April.
    8. Duncan Thomas, 1994. "Like Father, like Son; Like Mother, like Daughter: Parental Resources and Child Height," Journal of Human Resources, University of Wisconsin Press, vol. 29(4), pages 950-988.
    9. Wagstaff, Adam, 1986. "The demand for health : Some new empirical evidence," Journal of Health Economics, Elsevier, vol. 5(3), pages 195-233, September.
    10. Grossman, Michael, 2000. "The human capital model," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 7, pages 347-408, Elsevier.
    11. 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.
    12. Muurinen, Jaana-Marja, 1982. "Demand for health: A generalised Grossman model," Journal of Health Economics, Elsevier, vol. 1(1), pages 5-28, May.
    13. Michael Grossman, 1972. "The Demand for Health: A Theoretical and Empirical Investigation," NBER Books, National Bureau of Economic Research, Inc, number gros72-1, May.
    14. Duncan Thomas & John Strauss & Maria-Helena Henriques, 1991. "How Does Mother's Education Affect Child Height?," Journal of Human Resources, University of Wisconsin Press, vol. 26(2), pages 183-211.
    15. Clarke, Philip M., 1998. "Cost-benefit analysis and mammographic screening: a travel cost approach," Journal of Health Economics, Elsevier, vol. 17(6), pages 767-787, December.
    16. John Mullahy, 1999. "It'll only hurt a second? Microeconomic determinants of who gets flu shots," Health Economics, John Wiley & Sons, Ltd., vol. 8(1), pages 9-24, February.
    17. Litvack, Jennie I. & Bodart, Claude, 1993. "User fees plus quality equals improved access to health care: Results of a field experiment in Cameroon," Social Science & Medicine, Elsevier, vol. 37(3), pages 369-383, August.
    18. Lee, Lung-Fei, 1983. "Generalized Econometric Models with Selectivity," Econometrica, Econometric Society, vol. 51(2), pages 507-512, March.
    19. Winfried Pohlmeier & Volker Ulrich, 1995. "An Econometric Model of the Two-Part Decisionmaking Process in the Demand for Health Care," Journal of Human Resources, University of Wisconsin Press, vol. 30(2), pages 339-361.
    20. Vlassoff, Carol, 1994. "Gender inequalities in health in the third world: Uncharted ground," Social Science & Medicine, Elsevier, vol. 39(9), pages 1249-1259, November.
    21. Parker, Susan W. & Wong, Rebeca, 1997. "Household income and health care expenditures in Mexico," Health Policy, Elsevier, vol. 40(3), pages 237-255, June.
    22. 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.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Wendy Janssens & Jann Goedecke & Godelieve J de Bree & Sunday A Aderibigbe & Tanimola M Akande & Alice Mesnard, 2016. "The Financial Burden of Non-Communicable Chronic Diseases in Rural Nigeria: Wealth and Gender Heterogeneity in Health Care Utilization and Health Expenditures," PLOS ONE, Public Library of Science, vol. 11(11), pages 1-19, November.
    2. Felix Masiye & Oliver Kaonga & Joses M Kirigia, 2016. "Does User Fee Removal Policy Provide Financial Protection from Catastrophic Health Care Payments? Evidence from Zambia," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-15, January.
    3. Coast, Ernestina & Murray, Susan F., 2016. "“These things are dangerous”: Understanding induced abortion trajectories in urban Zambia," Social Science & Medicine, Elsevier, vol. 153(C), pages 201-209.
    4. Meike Irene Nakovics & Stephan Brenner & Paul Jacob Robyn & Ludovic Deo Gracias Tapsoba & Manuela De Allegri, 2019. "Determinants of individual healthcare expenditure: A cross‐sectional analysis in rural Burkina Faso," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1478-1494, October.
    5. Tin Su & Steffen Flessa, 2013. "Determinants of household direct and indirect costs: an insight for health-seeking behaviour in Burkina Faso," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(1), pages 75-84, February.
    6. Nadeem A. Burney & Mohammad Alenezi & Nadia Al-Musallam & Ahmed Al-Khayat, 2016. "The demand for medical care services: evidence from Kuwait based on households’ out-of-pocket expenses," Applied Economics, Taylor & Francis Journals, vol. 48(28), pages 2636-2650, June.
    7. Michael Grossman, 2022. "The demand for health turns 50: Reflections," Health Economics, John Wiley & Sons, Ltd., vol. 31(9), pages 1807-1822, September.
    8. Eva Deuchert, 2011. "The Virgin HIV Puzzle: Can Misreporting Account for the High Proportion of HIV Cases in Self-reported Virgins?," Journal of African Economies, Centre for the Study of African Economies, vol. 20(1), pages 60-89, January.
    9. Bansal, Prateek & Daziano, Ricardo A. & Sunder, Naveen, 2019. "Arriving at a decision: A semi-parametric approach to institutional birth choice in India," Journal of choice modelling, Elsevier, vol. 31(C), pages 86-103.
    10. Sepehri, Ardeshir & Sarma, Sisira & Oguzoglu, Umut, 2011. "Does the financial protection of health insurance vary across providers? Vietnam's experience," Social Science & Medicine, Elsevier, vol. 73(4), pages 559-567, August.
    11. 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.
    12. Xuedan You & Yasuki Kobayashi, 2011. "Determinants of out-of-pocket health expenditure in China," Applied Health Economics and Health Policy, Springer, vol. 9(1), pages 39-49, January.
    13. Qian, Dongfu & Lucas, Henry & Chen, Jiaying & Xu, Ling & Zhang, Yaoguang, 2010. "Determinants of the use of different types of health care provider in urban China: A tracer illness study of URTI," Health Policy, Elsevier, vol. 98(2-3), pages 227-235, December.
    14. Pokhrel, Subhash & Snow, Rachel & Dong, Hengjin & Hidayat, Budi & Flessa, Steffen & Sauerborn, Rainer, 2005. "Gender role and child health care utilization in Nepal," Health Policy, Elsevier, vol. 74(1), pages 100-109, September.
    15. Idrissa Beogo & Chieh-Yu Liu & Yiing-Jenq Chou & Chuan-Yu Chen & Nicole Huang, 2014. "Health-Care-Seeking Patterns in the Emerging Private Sector in Burkina Faso: A Population-Based Study of Urban Adult Residents in Ouagadougou," PLOS ONE, Public Library of Science, vol. 9(5), pages 1-11, May.
    16. Xu, Ke & Evans, David B. & Kadama, Patrick & Nabyonga, Juliet & Ogwal, Peter Ogwang & Nabukhonzo, Pamela & Aguilar, Ana Mylena, 2006. "Understanding the impact of eliminating user fees: Utilization and catastrophic health expenditures in Uganda," Social Science & Medicine, Elsevier, vol. 62(4), pages 866-876, February.
    17. Marta Caviglia & Marcelo Dell’Aringa & Giovanni Putoto & Riccardo Buson & Sara Pini & Daniel Youkee & Amara Jambai & Matthew Jusu Vandy & Paolo Rosi & Ives Hubloue & Francesco Della Corte & Luca Ragaz, 2021. "Improving Access to Healthcare in Sierra Leone: The Role of the Newly Developed National Emergency Medical Service," IJERPH, MDPI, vol. 18(18), pages 1-13, September.
    18. Zacharia S. Masanyiwa & Anke Niehof & Catrien J. A. M. Termeer, 2015. "A gendered users′ perspective on decentralized primary health services in rural Tanzania," International Journal of Health Planning and Management, Wiley Blackwell, vol. 30(3), pages 285-306, July.
    19. Aswathy Rachel Varughese & Indrajit Bairagya, 2023. "Socio-economic inequalities in spending on various levels of education across Indian households: an update," Indian Economic Review, Springer, vol. 58(1), pages 197-229, June.
    20. Ligane Séne & Momath Cissé, 2015. "Catastrophic out-of-pocket payments for health and poverty nexus: evidence from Senegal," International Journal of Health Economics and Management, Springer, vol. 15(3), pages 307-328, September.
    21. Pokhrel, Subhash, 2007. "Determinants of parental reports of children's illnesses: Empirical evidence from Nepal," Social Science & Medicine, Elsevier, vol. 65(6), pages 1106-1117, September.
    22. Finn McGuire & Noemi Kreif & Peter C. Smith, 2021. "The effect of distance on maternal institutional delivery choice: Evidence from Malawi," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2144-2167, September.
    23. Ziwei Zhang & Pu Ge & Mengyao Yan & Yuyao Niu & Diyue Liu & Ping Xiong & Qiyu Li & Jinzi Zhang & Wenli Yu & Xinying Sun & Zhizhong Liu & Yibo Wu, 2022. "Self-Medication Behaviors of Chinese Residents and Consideration Related to Drug Prices and Medical Insurance Reimbursement When Self-Medicating: A Cross-Sectional Study," IJERPH, MDPI, vol. 19(21), pages 1-19, October.
    24. 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.
    25. Akpalu, Wisdom, 2008. "On the Economics of Rational Self-Medication," Sustainability Indicators and Environmental Valuation Working Papers 6363, Fondazione Eni Enrico Mattei (FEEM).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Magnus Lindelow, 2004. "The Utilization of Curative Health Care in Mozambique: Does Income Matter?," Development and Comp Systems 0409057, University Library of Munich, Germany.
    2. Mocan, H. Naci & Tekin, Erdal & Zax, Jeffrey S., 2004. "The Demand for Medical Care in Urban China," World Development, Elsevier, vol. 32(2), pages 289-304, February.
    3. Sisira Sarma & Wayne Simpson, 2006. "A microeconometric analysis of Canadian health care utilization," Health Economics, John Wiley & Sons, Ltd., vol. 15(3), pages 219-239, March.
    4. Burggraf, Christine, 2017. "Russian demand for dietary quality: Nutrition transition, diet quality measurement, and health investment theory," Studies on the Agricultural and Food Sector in Transition Economies 269539, Institute of Agricultural Development in Transition Economies (IAMO).
    5. Sylvia Brandt & Peter Marie, 2011. "Racial Disparities in Hospital Length of Stay for Asthma: Implications for Economic Policies," Journal of Family and Economic Issues, Springer, vol. 32(1), pages 152-169, March.
    6. Hren Rok, 2012. "Theoretical shortcomings of the Grossman model," Bulletin: Economics, Organisation and Informatics in Healthcare, Sciendo, vol. 28(1), pages 63-75, January.
    7. repec:zbw:iamost:269539 is not listed on IDEAS
    8. Jacobson, Lena, 2000. "The family as producer of health -- an extended grossman model," Journal of Health Economics, Elsevier, vol. 19(5), pages 611-637, September.
    9. Grossman, Michael, 2006. "Education and Nonmarket Outcomes," Handbook of the Economics of Education, in: Erik Hanushek & F. Welch (ed.), Handbook of the Economics of Education, edition 1, volume 1, chapter 10, pages 577-633, Elsevier.
    10. Antonio Clavero Barranquero & Mª. Luz González Alvarez, 2005. "A survey of econometric models to analyze the demand and utilisation of health care," Hacienda Pública Española / Review of Public Economics, IEF, vol. 173(2), pages 129-162, June.
    11. Magnus Lindelow, 2003. "The Utilization of Curative Health Care in Mozambique: Does Income Matter?," Economics Series Working Papers WPS/2004-11, University of Oxford, Department of Economics.
    12. Bolin, Kristian & Jacobson, Lena & Lindgren, Bjorn, 2001. "The family as the health producer -- when spouses are Nash-bargainers," Journal of Health Economics, Elsevier, vol. 20(3), pages 349-362, May.
    13. Burggraf, Christine, 2017. "Russian demand for dietary quality: Nutrition transition, diet quality measurement, and health investment theory," Studies on the Agricultural and Food Sector in Transition Economies, Leibniz Institute of Agricultural Development in Transition Economies (IAMO), volume 86, number 86.
    14. Mwabu, Germano, 2007. "Health Economics for Low-Income Countries," Center Discussion Papers 10118, Yale University, Economic Growth Center.
    15. Bolin, Kristian & Liljas, Bengt & Lindgren, Björn, 2014. "Individual technologies for health - the implications of distinguishing between the ability to produce health investments and the capacity to benefit from those investments," Working Papers in Economics 587, University of Gothenburg, Department of Economics.
    16. Titus Galama & Arie Kapteyn & Raquel Fonseca & Pierre‐Carl Michaud, 2013. "A Health Production Model With Endogenous Retirement," Health Economics, John Wiley & Sons, Ltd., vol. 22(8), pages 883-902, August.
    17. Galama, Titus & Kapteyn, Arie, 2011. "Grossman’s missing health threshold," Journal of Health Economics, Elsevier, vol. 30(5), pages 1044-1056.
    18. Lindelow, Magnus, 2002. "Health care demand in rural Mozambique," FCND discussion papers 126, International Food Policy Research Institute (IFPRI).
    19. Ulf‐ G. Gerdtham, 1997. "Equity in Health Care Utilization: Further Tests Based on Hurdle Models and Swedish Micro Data," Health Economics, John Wiley & Sons, Ltd., vol. 6(3), pages 303-319, May.
    20. Chen, Keith & Lange, Fabian, 2008. "Education, Information, and Improved Health: Evidence from Breast Cancer Screening," IZA Discussion Papers 3548, Institute of Labor Economics (IZA).
    21. Angulo, Ana María & Barberán, Ramón & Egea, Pilar & Mur, Jesús, 2011. "An analysis of health expenditure on a microdata population basis," Economic Modelling, Elsevier, vol. 28(1), pages 169-180.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:hlthec:v:12:y:2003:i:9:p:755-770. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.