The Demand for Medical Care in Kenya

Abstract

We use a quantile regression method to analyse the demand effects of user fees over the entire distribution of visits in a sample of rural and urban populations controlling for other covariates of interest, notably income and demographics. We find that the negative effects of fees on attendance differ across the visit quantiles, with the smallest effects being felt at higher quantiles. The main contribution of the paper is to show the non-uniform effects of fees at different points of the visits distribution, in contrast to the average effect computed using the OLS method. The policy implications of the findings are briefly discussed.Re´sume´: Les auteurs du pre´sent article utilisent une me´thode de re´gres-sion quantile pour analyser l'incidence des frais impose´s aux usagers des services de sante´sur la demande de soins me´dicaux, en fonction de la re´partition globale des visites effectue´es par un e´chantillon de la population rurale et urbaine, et ve´rifier d'autres co-variables importantes, telles que le revenu et la de´mographie. Ils estiment que les effets ne´gatifs des frais impose´s aux usagers sur leur fre´quentation des centres de santev arient selon le nombre de fois ou`ceux-ci se rendent dans ces centres, car plus leur taux de fre´quentation est e´leve´, plus ces effets ne´gatifs sont insignifiants. La pre´sente e´tude a pour principal objet de montrer les effets non uniformes des frais impose´s aux usagers, a`diffe´rents points de re´parti-tion de leur fre´quentation des centres de sante´, par opposition aux effets moyens calcule´s selon la me´thode OLS. Elle traite brie`vement de l'incidence des re´sultats obtenus sur les politiques ge´ne´rales.

The Demand for Public Health Care and the Progressivity of Health Care Services in Ghana

“…Anyanwu (2007) using descriptive and conditional logit analysis to ascertain the choice of health care institutions by patients suffering from malaria in Nigeria finds that more women and children report ill, malaria fever dominates report patterns and money prices dominate health care demand while income negatively influences public care. Similarly, Mwabu et al (1993Mwabu et al ( , 2003 find in Kenya that a 10 per cent increase in the price of public health services reduces demand by only 1.0 percentage point while a 10 per cent increase in the price of private health services would reduce demand in private hospitals by 15.7 percentage points and 19.4 percentage points in private clinics. This suggests that increased user fees could generate additional revenue for the public sector without any significant reduction in demand.…”

“…There has been some empirical analysis of household choices between health care providers in developing countries (Gertler et al, 1987;Mwabu et al, 1993Mwabu et al, , 2003Akin et al, 1995;Glick and Razakamanantsoa, 2005;Sahn et al, 2003;Kasirye et al, 2004;Kamgnia, 2008;Amaghionyeodiwe, 2008;Faye, 2014). Akin et al (1995) estimated demand for health care in Nigeria and find that the price of health care is a significant determinant of the choice of health care provider, even after controlling for quality.…”

MDG Achievements, Determinants And Resource Needs : What Has Been Learnt ?

“…Education is typically found to be an important idiosyncratic determinant of health service use (Lavy et al 1996;Mwabu et al 2003;Sahn et al 2003).…”

“…When other factors are controlled for, higher incomes are typically associated with much higher rates of health service use (Mwabu et al 2003;Lay and Robilliard 2009). …”

“…Mwabu et al (2003) In addition to these universal factors, a number of cultural, religious, and social factors, within both the households and the larger community, are extremely important determinants of health service use. These typically interrelated factors obviously differ across countries, regions, and ethnic and religious groups, making it difficult to distinguish general patterns.…”