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Bypassing health providers : the quest for better price and quality of health care in Chad

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  • Gauthier, Bernard
  • Wane, Waly

Abstract

This paper investigates individuals'bypassing behavior in the health sector in Chad and the determinants of individuals'facility choice. The authors introduce a new way to measure bypassing using the patients'own knowledge of alternative health providers available to them instead of assuming that information as previously done. The authors analyze how perceived health care quality and prices impact patients'bypassing decisions. The analysis uses data from a Quantitative Service Delivery Survey in Chad's health sector carried out in 2004. The survey covers 281 primary health care centers and 1,801 patients. The matching of facility data and patient data allows the analysis to control for a wide range of important patient and facility characteristics, such as income, severity of illness, quality of health care, or price of services. The findings show that income inequalities translate into health service inequalities. There is evidence of two distinct types of bypassing activities in Chad: (1) patients from low-income households bypass high-quality facilities they cannot afford to go to low-quality facilities, and (2) rich individuals bypass low-quality facilities and aim for more expensive facilities that also offer a higher quality of care. These significant differences in patients'facility choices are observed across income groups as well as between rural and urban areas.

Suggested Citation

  • Gauthier, Bernard & Wane, Waly, 2008. "Bypassing health providers : the quest for better price and quality of health care in Chad," Policy Research Working Paper Series 4462, The World Bank.
  • Handle: RePEc:wbk:wbrwps:4462
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    References listed on IDEAS

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    1. Bernard Gauthier & Waly Wane, 2009. "Leakage of Public Resources in the Health Sector: An Empirical Investigation of Chad †," Journal of African Economies, Centre for the Study of African Economies (CSAE), vol. 18(1), pages 52-83, January.
    2. Leonard, Kenneth L, 2007. "Learning in Health Care: Evidence of Learning about Clinician Quality in Tanzania," Economic Development and Cultural Change, University of Chicago Press, vol. 55(3), pages 531-555, April.
    3. 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.
    4. 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.
    5. Leonard, Kenneth L., 2008. "Is patient satisfaction sensitive to changes in the quality of care? An exploitation of the Hawthorne effect," Journal of Health Economics, Elsevier, vol. 27(2), pages 444-459, March.
    6. Filmer, Deon & Hammer, Jeffrey S & Pritchett, Lant H, 2000. "Weak Links in the Chain: A Diagnosis of Health Policy in Poor Countries," World Bank Research Observer, World Bank Group, vol. 15(2), pages 199-224, August.
    7. World Bank, 2010. "World Development Indicators 2010," World Bank Publications, The World Bank, number 4373, April.
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    Citations

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    Cited by:

    1. Patrick Guillaumont & Laurent Wagner, 2014. "Aid Effectiveness for Poverty Reduction: Lessons from Cross‑country Analyses, with a Special Focus on Vulnerable Countries," Revue d’économie du développement, De Boeck Université, vol. 22(HS01), pages 217-261.
    2. Patrick GUILLAUMONT, 2009. "Aid effectiveness for poverty reduction: macroeconomic overview and emerging issues," Working Papers P05, FERDI.
    3. repec:kap:ijhcfe:v:17:y:2017:i:1:d:10.1007_s10754-016-9194-4 is not listed on IDEAS
    4. repec:kap:hcarem:v:21:y:2018:i:1:d:10.1007_s10729-016-9383-1 is not listed on IDEAS
    5. 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.
    6. Lewis, Maureen & Pettersson, Gunilla, 2009. "Governance in health care delivery : raising performance," Policy Research Working Paper Series 5074, The World Bank.
    7. Lourdes Diaz Olvera & Didier Plat & Pascal Pochet, 2011. "Se déplacer pour se soigner. Pratiques et obstacles à Conakry et Douala," Post-Print halshs-00733353, HAL.

    More about this item

    Keywords

    Health Monitoring&Evaluation; Health Systems Development&Reform; Health Law; Housing&Human Habitats; Gender and Health;

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