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Understanding spatial variation in the utilization of health services: does quality matter?

  • Magnus Lindelow
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    Utilization of health services are an important policy concern in most developing countries, reflecting both efforts to improve health outcomes and to meet international obligations to make health services broadly accessible. Although many policy and research initiatives have focused on the need to improve physical access, not enough is understood about what factors affect health care choices, and why low levels of utilization persists among certain socioeconomic groups or geographic regions despite improved physical access. Reflecting these concerns, this paper focuses on the role of health care quality in understanding spatial variation in the utilization of both curative and preventive health services in Mozambique. The analysis is based on matched household and facility data, where the sample of household was drawn from the catchment area of each facility. The findings show that health care quality is a significant and important factor in women`s choice of delivery location. In particular, both the presence of maternity staff and a broader service range make it more likely that women choose a facility-based delivery. Conversely, the analysis suggests that quality is not a significant determinant in decisions about outpatient visits, while physical access, education, and economic variables are important. The findings hence suggest that the impact of quality may be service specific, and that although certain dimensions of quality may have little or no impact on outpatient visits, they may be important determinants of the use of other health services. As developing countries to continue to face difficult trade-offs between quality and physical access in the allocation of resources, it will be important to deepen our understanding of how individuals make health care choices. The results presented in this paper are a step in that direction.

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    File URL: http://www.csae.ox.ac.uk/workingpapers/pdfs/2004-12text.pdf
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    Paper provided by University of Oxford, Department of Economics in its series Economics Series Working Papers with number WPS/2004-12.

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    Date of creation: 01 Dec 2003
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    Handle: RePEc:oxf:wpaper:wps/2004-12
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    Web page: http://www.economics.ox.ac.uk/
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    1. John S. Akin & David K. Guilkey & Paul L. Hutchinson & Michael T. Mcintosh, 1998. "Price elasticities of demand for curative health care with control for sample selectivity on endogenous illness: an analysis for Sri Lanka," Health Economics, John Wiley & Sons, Ltd., vol. 7(6), pages 509-531.
    2. Lavy, Victor & Quigley, John M., 1991. "Willingness to Pay for the Quality and Intensity of Medical Care: Evidence from Low Income Households in Ghana," Department of Economics, Working Paper Series qt4p02g6nq, Department of Economics, Institute for Business and Economic Research, UC Berkeley.
    3. 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.
    4. Thomas Mroz & Kenneth Bollen & Ilene Speizer & Dominic Mancini, 1999. "Quality, accessibility, and contraceptive use in rural tanzania," Demography, Springer, vol. 36(1), pages 23-40, February.
    5. Williams, Brian & Coyle, Joanne & Healy, David, 1998. "The meaning of patient satisfaction: An explanation of high reported levels," Social Science & Medicine, Elsevier, vol. 47(9), pages 1351-1359, November.
    6. Gertler, Paul & Locay, Luis & Sanderson, Warren, 1987. "Are user fees regressive? : The welfare implications of health care financing proposals in Peru," Journal of Econometrics, Elsevier, vol. 36(1-2), pages 67-88.
    7. Alderman, Harold & Lavy, Victor, 1996. "Household Responses to Public Health Services: Cost and Quality Tradeoffs," World Bank Research Observer, World Bank Group, vol. 11(1), pages 3-22, February.
    8. Gertler, Paul J & Waldman, Donald M, 1992. "Quality-Adjusted Cost Functions and Policy Evaluation in the Nursing Home Industry," Journal of Political Economy, University of Chicago Press, vol. 100(6), pages 1232-56, December.
    9. Akin, John S, et al, 1986. "The Demand for Primary Health Care Services in the Bicol Region of the Philippines," Economic Development and Cultural Change, University of Chicago Press, vol. 34(4), pages 755-82, July.
    10. Lavy, Victor & Strauss, John & Thomas, Duncan & de Vreyer, Philippe, 1996. "Quality of health care, survival and health outcomes in Ghana," Journal of Health Economics, Elsevier, vol. 15(3), pages 333-357, June.
    11. Weisbrod, Burton A, 1991. "The Health Care Quadrilemma: An Essay on Technological Change, Insurance, Quality of Care, and Cost Containment," Journal of Economic Literature, American Economic Association, vol. 29(2), pages 523-52, June.
    12. Feyisetan, Bamikale J & Ainsworth, Martha, 1996. "Contraceptive Use and the Quality, Price, and Availability of Family Planning in Nigeria," World Bank Economic Review, World Bank Group, vol. 10(1), pages 159-87, January.
    13. Akin, John S. & Guilkey, David K. & Hazel?Denton, E., 1995. "Quality of services and demand for health care in Nigeria: A multinomial probit estimation," Social Science & Medicine, Elsevier, vol. 40(11), pages 1527-1537, June.
    14. Gilson, Lucy & Kitange, Henry & Teuscher, Thomas, 1993. "Assessment of process quality in Tanzanian primary care," Health Policy, Elsevier, vol. 26(2), pages 119-139, December.
    15. Annandale, Ellen & Hunt, Kate, 1998. "Accounts of disagreements with doctors," Social Science & Medicine, Elsevier, vol. 46(1), pages 119-129, January.
    16. Peabody, John W. & Gertler, Paul J. & Leibowitz, Arleen, 1998. "The policy implications of better structure and process on birth outcomes in Jamaica," Health Policy, Elsevier, vol. 43(1), pages 1-13, January.
    17. Campbell, S. M. & Roland, M. O. & Buetow, S. A., 2000. "Defining quality of care," Social Science & Medicine, Elsevier, vol. 51(11), pages 1611-1625, December.
    18. Mwabu, Germano M., 1986. "Health care decisions at the household level: Results of a rural health survey in Kenya," Social Science & Medicine, Elsevier, vol. 22(3), pages 315-319, January.
    19. Schwartz, J Brad & Akin, John S & Popkin, Barry M, 1988. "Price and Income Elasticities of Demand for Modern Health Care: The Case of Infant Delivery in the Philippines," World Bank Economic Review, World Bank Group, vol. 2(1), pages 49-76, January.
    20. 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.
    21. De Geyndt, W., 1995. "Managing the Quality of Health Care in Developing Countries," Papers 258, World Bank - Technical Papers.
    22. Jowett, Matthew, 2000. "Safe motherhood interventions in low-income countries: an economic justification and evidence of cost effectiveness," Health Policy, Elsevier, vol. 53(3), pages 201-228, October.
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