Bypassing Health Providers : The Quest for Better Price and Quality of Health Care in Chad
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World Bank, Washington, DC
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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.
Palabras clave
ABILITY TO PAY, ACCESS TO HEALTH SERVICES, AILMENT, ANIMAL HEALTH, BEDS, BIRTHS, CLINICS, DEATHS, DIAGNOSIS, DIRECT COSTS, DISTRICTS, DOCTOR, DOCTORS, DRUGS, DWELLING, ECONOMIC DEVELOPMENT, EXPENDITURES, GENDER, HEALTH CARE, HEALTH CARE CENTERS, HEALTH CARE INFRASTRUCTURE, HEALTH CARE MARKETS, HEALTH CARE PROVIDER, HEALTH CARE PROVIDERS, HEALTH CARE QUALITY, HEALTH CARE SERVICES, HEALTH CENTERS, HEALTH CENTRES, HEALTH CLINICS, HEALTH FACILITIES, HEALTH INDICATORS, HEALTH POLICIES, HEALTH POLICY, HEALTH PROVIDERS, HEALTH SECTOR, HEALTH SERVICE, HEALTH SERVICE PROVIDERS, HEALTH SERVICE PROVISION, HEALTH SERVICES, HEALTH STATUS, HEALTH SYSTEM, HEALTH WORKERS, HOMES, HOSPITALIZATION, HOSPITALS, HOUSEHOLDS, HUMAN DEVELOPMENT, ILLNESS, ILLNESSES, INCOME, INFECTIOUS DISEASES, INFORMAL CARE, INHABITANTS, INTERVENTION, LIFE EXPECTANCY, MEDICAL CARE, MEDICAL FACILITIES, MEDICAL PERSONNEL, MEDICAL TREATMENT, MEDICATION, MEDICINE, MIDWIVES, MORTALITY, MORTALITY RATE, MOTHER, NEIGHBORHOOD, NURSES, PATIENT, PATIENTS, PHARMACIES, PRIMARY CARE, PRIMARY HEALTH CARE, PROBABILITY, PUBLIC HEALTH, QUALITY OF CARE, QUALITY OF HEALTH, QUALITY OF HEALTH CARE, RURAL AREA, RURAL AREAS, SOCIAL SCIENCE, URBAN AREAS, URBAN POPULATIONS, VACCINATION, VILLAGES, VISITS, WORK FORCE, WORKERS