Demand for Health Care Services in Nigeria: Implications for Poverty Reduction
CHAPTER ONE
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:
- To assess the health care services utilization patterns of households in chiocha.
- To point out the determinants of demand for health care services.
- To explore the factors that affects the people’s choice towards different health care providers.
CHAPTER TWO
LITERATURE REVIEW
Theoretical Review
Health
Health is a component of human capital, which in some recent literature is referred to as health human capital to distinguish it from education human capital. The world health organization (WHO), the key United Nations (UNs) agency concerned with global health matters defined health as, “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity” (WHO, 1947). Conceptually, to be healthy means more than not having disease or infirmity, but to be harmony with oneself and environment.
Health human capital expected to have a positive correlation with other forms of human capital. Healthy individuals, for instance, are on average better nourished and better educated than individuals in poor health. Both health and education increase labor productivity, but the unique feature that differentiate health from education is that health by reducing the time spent in sickness, it increases the total amount of time available to produce money earnings and commodities, as well as the time available for leisure (Grossman, 1972).
Health care
Conceptually health and health care are two distinct subject matters. The basic difference between health and health care is that health care is tradable in markets while health is not. However, health care markets are imperfect. The imperfection arises from the special characteristics of health care (Mwabu, 2007). Arrow to show the distinction between the health and health care he said that “It should be noted that the subject is the medical-care industry, not health” (Arrow, 1963, p. 940). The distinction is important because in the real world only markets for health care are observed but not for health.
The nature of demand for health care
The generalized framework under welfare analysis can be formulated under the consumer‟s demand analysis. Generally, demand analysis describes the relationship between quantities of goods and services desired to be purchased and the price charged for good and service, assuming that not all other factors (income level, tastes, needs, and demographic factors, cultural and traditional beliefs) are changed. However, behavior in health market is distinguished by the roles that physical needs and life cycle patterns play in determining demand.
The health care consumption decision is a result of circumstances like infections, accidents and pregnancies, and other health problems. Other reasons for medical consumption decisions related to age and age-sex specific, including the onset of degenerative disease rate in life, immunization in early life and the risk of pregnancy during fertile years for women (Akin et al.1985). Due to this reason, the demand for health, whether preventive or curative is a “derived demand “. This is because health is not only demanded for its own sake, but, also to enable individuals to lower the amount of time lost through ill health which can be devoted to the production of economic activities(Grossman, 1972).
CHAPTER THREE
RESEARCH DESIGN AND METHODOLOGY
Data Sources and Types
The data for this study was mainly primary and cross sectional that was collected from sample respondents of choba community through household sample survey. The study used different secondary sources of information like the city health office report, journals, books and other secondary source of information that was necessary.
The survey was capturing the first visits to health facilities. This is due the fact that patients may visit more than one provider for a single incidence of illness. Therefore, choice of provider is limited to a first outpatient consultation. The questionnaire was designed to illicit information on household characteristics and the perception of households regarding health and health care providers. The survey was undertaken during the month of February 2013 for one week. For this survey, five enumerators and two supervisors were employed and trained adequately to enable them to have full understanding of the purpose of the survey and the meaning of each question.
Data Collection Technique
The primary data used for this study was collected through structured questionnaire from the respondents of the city. The designed questionnaire was presented to the sample households that experience illness or injury over the one month immediately preceding the interview. Therefore, the analysis was depending on those individuals who face illness. The one-month period is used as a standard in health care demand literature to collect data from those who experience illness.
CHAPTER FOUR
In this chapter, the collected data both quantitative and qualitative is going to be discussed and analyzed using statistical tools of descriptive analysis and econometric analysis.
Descriptive analysis
This section provides the level of utilization of different health care providers by the sample households assessed using some demographic factors as well as the important determinants of demand such as economic factors like income, direct and indirect medical costs, and subjective variables such as perceived quality of treatment and behavior of the staff members while providing treatments. Economic, demographic, and subjective variables are analyzed to indicate factors that determine the decision of seeking treatment and factors that affect choice between health care providers.
CHAPTER FIVE
CONCLUSION AND RECOMMENDATION
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.
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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