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


  • Catharina Hjortsberg


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.

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  • 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.
  • Handle: RePEc:wly:hlthec:v:12:y:2003:i:9:p:755-770 DOI: 10.1002/hec.839

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    References listed on IDEAS

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    2. 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.
    3. 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 (CSAE), vol. 20(1), pages 60-89, January.
    4. 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.
    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. 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.
    7. Vicenzo Carrieri & Marcel Bilger, 2009. "Preventive care: underused even when free. A tale from Italy," Research Papers by the Institute of Economics and Econometrics, Geneva School of Economics and Management, University of Geneva 2009.02, Institut d'Economie et Econométrie, Université de Genève.
    8. 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.
    9. 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.
    10. 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.
    11. 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.
    12. 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.
    13. 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.

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