The Individual's Choice of Facility for Maternal Health and Family Planning Services in a Dense Urban Environment: The Case of Senegal

Posted: 6 Oct 2016

See all articles by Christopher Cronin

Christopher Cronin

University of Notre Dame, Department of Economics

David K. Guilkey

University of North Carolina (UNC) at Chapel Hill - Department of Economics

Ilene Speizer

Gillings School of Public Health, Department of Maternal and Child Health and Carolina Population Center

Date Written: October 5, 2016

Abstract

A number of authors have utilized health facility choice models to determine how individuals in developing countries evaluate the tradeoff between the price, quality, and indirect costs of obtaining medical care. A common problem in this literature is that researchers only observe the type of facility that an individual reports visiting (e.g., public or private hospital, health center or dispensary; or traditional healer) and, therefore, must assume patients visit the nearest facility of the type they report. This matching procedure creates measurement error in the choice variable, which may introduce bias in parameter estimates. In this research, we use a data set from urban Senegal that allows for a precise individual-health facility match to estimate consumer preferences for health facility characteristics related to maternal health and family planning services. Using actual rather than imputed choices, we find that consumers prefer high quality health facilities that are nearby. Given the preference for quality, our findings indicate that in contrast to the typical assumption in the literature, individuals frequently bypass the facility nearest their home. When we estimate models using the mismeasured choice variable, the results show a significant bias in preference estimates; most notably, these models systematically overestimate distaste for travel. To highlight a potential consequence of biased preference estimates in this setting, we conclude by simulating the impact of an actual policy that took place in 2014; namely, the opening of a new facility in a previously underserved area of Dakar, Senegal.

Keywords: Discrete Choice, Urban Health, Measurement Error, Senegal, Family Planning, Maternal Health

JEL Classification: I2, I15, I18, J13

Suggested Citation

Cronin, Christopher and Guilkey, David K. and Speizer, Ilene, The Individual's Choice of Facility for Maternal Health and Family Planning Services in a Dense Urban Environment: The Case of Senegal (October 5, 2016). Available at SSRN: https://ssrn.com/abstract=2848295 or http://dx.doi.org/10.2139/ssrn.2848295

Christopher Cronin (Contact Author)

University of Notre Dame, Department of Economics ( email )

Notre Dame, IN 46556-5646
United States

David K. Guilkey

University of North Carolina (UNC) at Chapel Hill - Department of Economics ( email )

Chapel Hill, NC 27599
United States
919-966-2385 (Phone)
919-966-4986 (Fax)

Ilene Speizer

Gillings School of Public Health, Department of Maternal and Child Health and Carolina Population Center ( email )

102 Ridge Road
Chapel Hill, NC NC 27514
United States

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