Bypassing Health Centers in Tanzania: Revealed Preferences for Observable and Unobservable

Columbia University Discussion Paper No. 0001-02

43 Pages Posted: 29 May 2001

See all articles by Kenneth L. Leonard

Kenneth L. Leonard

University of Maryland

Gilbert R. Mliga

Government of Tanzania

Damen Haile Mariam

Addis Ababa University - School of Public Health

Date Written: April 2001

Abstract

When patients bypass one health facility to seek health care at another, strong preferences are revealed. This paper advances the view that the patterns of bypassing observed in Iringa Rural district in Tanzania show evidence of patients' understanding of various measures of quality at the facilities that they visit and bypass. Importantly some of these measures are 'unobservable,' meaning that we do not expect patients to be able to evaluate whether or not these types of quality are present just from visiting a center. We use two data sets on various features of health facilities including consultation quality and prescription quality as evaluated by a team of clinicians. This is matched with data collected from health center registers that included the symptoms of patients and the village they traveled from. The register data is transformed into a patient-based sample and we use a multinomial/conditional logit regression on patient choice of provider to show the relationship between patient behavior and objective measure of technical quality in the health facilities. Patients seek facilities that provide high quality consultations, are staffed by more knowledgeable physicians, observe prescription practices, and are polite. They avoid facilities that use injections too liberally or over-prescribe medication.

Keywords: Health Center Bypassing, NGO, Rural Health Care, Tanzania, Technical Quality, Agency in Health Care

JEL Classification: I1, 01, 02

Suggested Citation

Leonard, Kenneth L. and Mliga, Gilbert R. and Mariam, Damen Haile, Bypassing Health Centers in Tanzania: Revealed Preferences for Observable and Unobservable (April 2001). Columbia University Discussion Paper No. 0001-02, Available at SSRN: https://ssrn.com/abstract=271024 or http://dx.doi.org/10.2139/ssrn.271024

Kenneth L. Leonard (Contact Author)

University of Maryland ( email )

Symmons Hall, Rm 2200
University of Maryland
College Park, MD 20742-5535
United States

HOME PAGE: http://faculty.arec.umd.edu/kleonard/

Gilbert R. Mliga

Government of Tanzania

Ministry of Health
Dar Es Salaam
Tanzania

Damen Haile Mariam

Addis Ababa University - School of Public Health

Addis Ababa
Ethiopia

Do you have a job opening that you would like to promote on SSRN?

Paper statistics

Downloads
171
Abstract Views
1,671
Rank
372,584
PlumX Metrics