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

  • Paul Collier

    (Centre for the Study of African Economies)

  • Stefan Dercon

    (Centre for the Study of African Economies)

  • John Mackinnon

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 the quality 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.

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File URL: http://econwpa.repec.org/eps/dev/papers/0409/0409052.pdf
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Paper provided by EconWPA in its series Development and Comp Systems with number 0409052.

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Length: 43 pages
Date of creation: 28 Sep 2004
Date of revision:
Handle: RePEc:wpa:wuwpdc:0409052
Note: Type of Document - pdf; pages: 43
Contact details of provider: Web page: http://econwpa.repec.org

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  1. 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.
  2. 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.
  3. Thomas, D. & Lavy, V. & Strauss, J., 1991. "Public Policy and Anthropometric Outcomes in the Cote d'Ivoire," Papers 643, Yale - Economic Growth Center.
  4. 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.
  5. Appleton, Simon, 1998. "The Impact of Public Services on Health Care and Illness: A Treatment Effects Model with Sample Selectivity," Journal of African Economies, Centre for the Study of African Economies (CSAE), vol. 7(1), pages 1-33, March.
  6. Filmer, Deon & Hammer, Jeffrey & Pritchett, Lant, 1998. "Health policy in poor countries : weak links in the chain," Policy Research Working Paper Series 1874, The World Bank.
  7. Lavy, V & Strauss, J & Thomas, D & de Vreyer, P, 1996. "Quality of Health Care, Survivial and Health Outcomes in Ghana," Papers 96-20, RAND - Reprint Series.
  8. 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.
  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. Rosenzweig, Mark R & Wolpin, Kenneth I, 1986. "Evaluating the Effects of Optimally Distributed Public Programs: ChildHealth and Family Planning Interventions," American Economic Review, American Economic Association, vol. 76(3), pages 470-82, June.
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