Demand For Health Care Services In Nigeria; Implications For Poverty Reduction

Project and Seminar Material for Public Health

Demand For Health Care Services In Nigeria; Implications For Poverty Reduction


Abstract


This study examines the factors that associated with the decision of consulting medical treatment and the choice between health care service providers using primary data collected from Choba community, River state. While household level factors expected to affect the decision to consult medical treatment, patient and provider specific factors included as potential determinants of choice among different health care service providers. The nested multinomial logit NMNL) estimated using full information maximum likelihood (FIML) technique that estimates both levels of decisions simultaneously. However, number of children in the household negatively and significantly affects the decision to consult modern care. In the lower level of the model, the probability of consulting both public and private health care increase with log of consumption and quality of treatment, but decline with patients age. While patients’ primary education increases the probability of consulting public provider, secondary and above education increases the likelihood of consulting private care relative to the no-care. Therefore, the result indicates user fees would be regressive in that they would reduce health care services utilization of the poor segment of population than the rich.


Table Of Content


Preliminary Page(s)

  • Title Page
  • Declaration
  • Approval
  • Dedication
  • Acknowledgement
  • Abstract
  • Table of Content

Chapter One

Introduction

  • 1.1 Background To the study
  • 1.2 Statement of the problem
  • 1.3 Objectives of the study
  • 1.5 Research Question
  • 1.6 Significance of the study
  • 1.7 Scope of the study
  • 1.8 Limitation of the study

Chapter Two

Literature Review

  • 2.1 Theoretical Review
  • 2.2 Health Care Demand Model and Methodologies
  • 2.3 Empirical Reviews

Chapter Three

Research Design and Methodology

  • 3.1 Data Sources and Types
  • 3.2 Data Collection Technique
  • 3.3 Sampling Procedure
  • 3.4 Model specification

Chapter Four

Presentation of Data and Analysis

  • 4.1 Descriptive analysis
  • 4.1.2 Economic factors affecting demand for health care
  • 4.1.3 Demographic factors and demand for health care services

Chapter Five

Conclusion and Recommendation

  • 5.1 Conclusion
  • 5.2 Recommendations
  • Reference

Chapter One


Introduction

1.1 Background of the study

Using the 2002/03 Uganda National Household Survey data we empirically examine the nature and determinants of individuals’ decision to seek care on condition of illness reporting. The major findings include: cost of care is regressive and sustainability reduces the health care utilization for any formal provider by the poorer individuals afters controlling for other factors. In other words, even among public facilities cost of care remains a barrier to utilization of these services. Second, there is no doubt that putting in place strategies aimed at increasing the income of the poor will increase their utilization of the health facilities, though the impact will be higher for private care. Third, besides income and cost and cost of care, other factors in particular qualify of services, education and physical access proxied by distance to the facilities are important determinants of health care utilization. Four, as much as it is important for the government to improve provision of services in the public facilities, incentives should be put in place to encourage and strengthen the role of the private sector. At the same time there is need, to put in place a regulatory system, set standards and a monitoring framework to ensure quality of services and control prices in the private sector especially in the private for profit sub-sector. Clearly there is an increasing preference for the sector’s services even after the abolition of cost sharing.

According to various health status indicators, the Nigerian population health status is very low. Generally, low life expectancy, high infant, child and maternal mortality, low immunization coverage, and low access to proper sanitation characterize Nigeria.Under-5 year mortality and maternal mortality rates are very high; 166 per 1,000 live birth and 850 per 100,000, respectively (WHO 2011b).

Despite major progresses have been made to improve the health status of the population in the last two decades, Nigeria’s population still face a high rate of morbidity and mortality and the health status remains relatively poor. Following changes of government in 1991, the new government of Nigeria introduced the health policy that was the first of its kind in the country and was among a number of political and socio-economic transformation measures that taken place. To achieve the objective of the health sector, the government of Nigeria designed the Health Sector Development Programs (HSDP). This has been a 20-years health development strategy implementing through a series of four consecutive 5-year investment programs (MOH, 2010). The first phase (HSDP I) was initiated in 1996/97. This program had the objectives of increasing access of health care, improving service quality, improving health service management and increasing the participation of private and NGO sectors in health service provision. Moreover, decentralization of the health care delivery system is also considered as a measure to improve health service management and resource mobilization ((MOH, 2010), 2010).

Despite this effort, there is no significant improvement in health service utilization and health care financing aspects as compared to a significant increase in health facility construction. In addition, the participation of the private and NGO sectors has been below expectations as they are concentrated in urban areas (MOH, 2010).
One way of ensuring the effectiveness and sustainability of the programs and policies in the health sector would be the involvement of households in designing such policies and programs. For instance, identifying the factors that determine households demand for health care services could be of vital role in assisting of rational strategies. The utilization of health care services depends on demand factors such as income, cost of care, education, social norms and traditions, and the quality and appropriateness of the services provided. Therefore, interest should not only on merely provision of physical access, but also should ensure that effective utilization of those services among sick group of the population. (M. Lindelow, 2003). By keeping the above in mind, this study concerned with determining the factors that are associated with the decision of seeking medical treatment and the choice of health service providers.


1.2 Statement of the problem

Health is a main target of all households and governments in all countries. The health status of the population is the reflection of the level of economic development of the country. In the same way, the economic progress of the country influenced by the health status of the population. Hence, the two are interdependent as people are both the driving force and final targets of socioeconomic development. For this reason, the provision of health service becomes an important aspect of the socio-economic development of a country. Many studies (such as M. Lindelow, 2003,Kasirye et al.2004, Mwabu et al. 2004,I. Barnett et al.2010, and Mawuli G., 2011) indicate that health service interventions are important in the development of human resources and healthy society that contribute positively to the development of the economy.

Most developing countries consider promoting health care utilization as an important policy concern for two reasons; one is to improve health outcomes and the other is to meet international obligations to make health services broadly accessible. However, many policy and research initiatives focused on improving physical access rather to focus on both physical access and the pattern of health care service utilization. For this reason, not enough is understood about the factors that associated with low level of utilization among certain groups despite improved physical access (M. Lindelow, 2003). Physical access by itself is not an end and to achieve the target of healthy population it should accompanied by enough utilization among sick groups.

Nigeria is among countries with lowest health status in the world. In addition to low level of health status, the problem in Nigeria and most developing countries is the low level of health care utilization. This indicates the need to assess consumer behaviors that may affect the demand for health care besides the availability of low or free provision of health care services (Tesfaye A., 2003). Some findings suggest that demand-side barriers play a crucial role as the supply side factors in preventing patients from obtaining treatment. However, relatively little attention is given by policy makers and researchers to ways minimize their effect (T. Ensor and S. Cooper, 2004).Early policy and research initiatives focused on the need to improve physical access through an expansion of the network of facilities. However, a growing literature on health care demand has pointed out that individuals are not passive recipients of health services; rather they make active choices about whether or not to make use of provided health care services (M. Lindelow, 2003).

There are government efforts to address problems facing the health sector with a bias on the supply side such as construction of new health centers. Howeve, we need to think beyond supply and consider individuals behaviour during illness. Further we need to understand the nature and the magnitude of the factors that affecting their demand for medical care (Kasirye et al. 2004). Therefore, it is important to identify the factors that determine the demand for health care services. As the policy priority area is improving the health status of the population, we should investigate in different factors that directly and indirectly influence the demand of the health care services. That is, it necessary to analyze the demand for health care services by identifying the factors that affect individuals‟ decisions to seek health care services and to choose among different providers (N. Asteraye,2002).

In general, this study is going to answer the following questions. What are the major determinates of demand of the society for medical treatment? What factors determine the choice of medical treatment seekers among different providers of health service? Are the health seeking behaviour differ across the poor and the non-poor? And what is the health seeking behaviour of the other socially vulnerable groups such a women ? By answering theses and related questions, the study provided policy implications that promote the health care utilization within the society that is a key to create healthy and productive society.


1.3 Objectives of the study

The general objective of the study is to explore the determinants of demand for health care services and show their implication on health care policy.

Specifically, the objectives of this study:

  1. To assess the health care services utilization patterns of households in chiocha.
  2. To point out the determinants of demand for health care services.
  3. To explore the factors that affects the people’s choice towards different health care providers.

1.5 Research Question

  1. What is the health care services utilization patterns of households in Chioba community?
  2. What are the determinants of demand for health care services?
  3. What are the factors that affects the people’s choice towards different health care providers?

1.6 Significance of the study

Understanding of determinants of demand for health care services would enable policy makers to introduce and implement appropriate incentive schemes that could be used to encourage better utilization of health care services.

Thus, the study can contribute some findings that may help policy makers to formulate effective policy for health care system that brings better health care services utilization. In addition, the study might have significant role in giving direction for those who want to undertake further research on the subject matter. In general, the study might have significant importance on provision of information based on stated objectives.


1.7 Scope of the study

Study was focused on determining the factors that are associated with the decision of seeking medical treatment and the choice of health service providers in times of illness by taking sample households from Choba community, Rivers State. Therefore, the study was limited to Choba household respondents, in which the data was gathered to determine the factors that affect households demand for health care services.


1.8 Limitation of the study

Self-reported illness and first consultation with health care providers are used for this empirical analysis of demand for health care. However, Self-reported illness may produce biased results as the perception of illness may be different for poor and non-poor individuals and perception about a disease affects the choice of health care services and providers. Consumers may consult more than one provider for treatment for the same episode; therefore, analysis based on the first visit to health care provider may not capture the complex decision-making behavior of the people. Moreover, the study used perceived quality (subjective quality) of care, i.e. consumer’s assessment of the relative quality of different health care providers as a proxy for provider’s quality of treatment. However, consumers may not be able to evaluate the biomedical and technical aspects of modern treatment. Thus, it may not be a correct proxy for quality of treatment. The generalizations and deductions that come from this study may not indicate the whole country. Despite these problems, maximum effort is made to get the relevant information and to come up with a better finding and conclusion.


Chapter Five


Conclusion and Recommendation

5.1 Conclusion

The provision of proper health care services is considered as important aspect of the socioeconomic development of any country. However, there is a need to think beyond the provision of health care services, and consider factors that affect households‟ decision of consulting treatment and their choice among different health care services providers. An individual who experience illness or injury decision makes first whether to consult medical treatment or not and then decision of his (her) choice among different health care providers. Therefore, this paper tried to investigate those factors associated with both levels of households‟ decision-making.

The paper is based on a primary data collected from respondents in Choba community in River state and tried to examine the factors that determine the medical treatment consultation behavior at times of illness and the choice of health care service providers using both descriptive and econometric analysis. To achieve the object of identifying the determinants of consultation behavior and choice between different health care services providers, this paper employed NMLM estimated using full information maximum likelihood technique.

Estimation of the lower level model (provider choices) indicates that, log of consumption, patient’s age, patient’s education, and perceived quality of treatments are found to be significant factors that affect the choices between health care services providers. All these variables have positive effect on the demand for both public and private health care providers except patient‟s age. At the same time the estimation results of the upper level model indicate patient education, number of days suffered and number of children in a household significantly affect the decision of consulting modern care. Education and number of days suffered are found positively related whereas and number of children negatively affects the decision to seek modern care. However, patient and household head sex, and household age are found insignificant determinants of demand for health care services.

Primary education of patient has found positive and significantly affect the probability of consulting public health care services providers. Similarly, the probability of consulting private health care service providers is affected positively and significantly by patients‟ secondary and tertiary education. The result indicates investing in education may increase the probability of consulting both kinds of health care service providers. Demand for modern treatment also positively and significantly affected by household head’s education. The more educated the household head is the more likely to consult medical treatment at the time of illness.

Household structure is another factor that affects decision to consult modern treatment. Both number of children and adults in the family have negative effect on demand for modern treatment but the effect is significant only for the former groups. The demand for both private and public providers decline with patient’s age and this suggest adults reduce health care utilization as they grow older.

Quality of services provided by different health care service providers is also another crucial factor that affects demand for different health care service providers. The effect found to be positive and significant for both providers. Severity of illness as measured by duration of illness is found a significant determinant of seeking modern care. As expected the probability of seeking health care is positively correlated with the number of days lost due to illness.

Further, log of consumption was found a significant determinant of demand for both health care services providers implying both income and cost of treatment are important determinants. To explore the effect of cost of care on health care demand, arc price elasticity estimated for different income groups. Computation of the arc price elasticities shows that elasticities are negative over all prices and income groups. Demand is more price elastic at lower incomes and at higher level of prices. Therefore, those in lower income group are more price sensitive than the rests. Health care demand is also more price elastic for public health care provider than private one.


5.2 Recommendations

The level of education of the person has a positive effect on the probability of consulting modern medical care. The result indicates education play a significant role in individual’s decision to consult modern care at the time of illness. Hence, the policy lesson is expansion of education could be one component of creating healthy and productive society. Since significant proportions of adults are illiterate, the government needs to supplement the formal education with the informal one to create awareness about health among adult illiterates.

Individuals‟ perception about their illness plays a significant role in their decision of consulting modern care. This implies individuals are more willing to consult modern care if they think the illness is serious. This indicates the government need to design policies that pooled individual patient to modern care services at the time of illness. For instance, creating public awareness on health problem risks plays a crucial role in this respect.

Demand for modern care decline with the number of children in the household. This may be resulted from large dependent household members that reduce the resource available for treatment. Even though great achievements have been made in Ethiopia in the last three decades, the government still has serious homework in expansion of family planning services. Therefore, the government needs to strengthen the family planning even in urban areas.
Patients‟ perceived quality of treatment is another factor that increases the probability of consulting modern care. This necessitates the government need to invest more to improve the quality of services provided by the public health care service providers. The government also should design some mechanisms that ensure the quality of health care services provided by the private health care service providers.


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