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Health Care Demand in Rural Mozambique: Evidence from the 1996/97 Household Survey

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Health Care Demand in Rural Mozambique: Evidence from the 1996/97 Household Survey View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Research Papers in Economics FCND DP No. 126 FCND DISCUSSION PAPER NO. 126 HEALTH CARE DEMAND IN RURAL MOZAMBIQUE: EVIDENCE FROM THE 1996/97 HOUSEHOLD SURVEY Magnus Lindelow Food Consumption and Nutrition Division International Food Policy Research Institute 2033 K Street, N.W. Washington, D.C. 20006 U.S.A. (202) 862–5600 Fax: (202) 467–4439 February 2002 FCND Discussion Papers contain preliminary material and research results, and are circulated prior to a full peer review in order to stimulate discussion and critical comment. It is expected that most Discussion Papers will eventually be published in some other form, and that their content may also be revised. ii ABSTRACT Despite rapid economic growth in recent years, Mozambique remains a very poor country. Expenditure-based poverty measures are reflected in widespread food insecurity and poor health status. In recognition of these problems, the Government of Mozambique is promoting expanded and improved quality and equity in access to health care as an important component in the global strategy to fight poverty. Given years of colonial neglect and systematic destruction of health facilities during the civil war, recent government policy has focused on expanding the rural health network. However, insofar as the ultimate objective of the provision of curative services is to ensure that those in need of care receive effective treatment, it is also necessary to think beyond supply. Specifically, we need to consider how individuals behave during episodes of illness, and what factors affect this behavior. This paper provides quantitative evidence on the importance of individual, household, and community characteristics on individuals’ care- seeking decisions during episodes of illness. The paper estimates a “flexible” multinomial model of health care provider choice conditional on illness using data from the 1996/97 Mozambique National Household Survey on Living Conditions (IAF). The empirical analysis is underpinned by a basic theoretical framework of utility maximization and household production of health. A number of individual and household characteristics, e.g., age, education, and reported symptoms, stand out as highly significant determinants of health seeking behavior. Also, prices, defined in the model as the composite of user fees and time costs associated with consultations at different providers, are found to be iii important determinants of choice. The results indicate that the eradication of poverty, independent of improvements in physical access to health care and education, will have only a negligible effect on health care choices. iv CONTENTS Acknowledgments............................................................................................................. vii 1. Introduction..................................................................................................................... 1 2. Health and Health Care in Mozambique......................................................................... 3 A Historical Perspective .............................................................................................. 3 General Background............................................................................................. 3 The Health Sector................................................................................................. 5 The Institutional and Policy Framework ..................................................................... 7 Socioeconomic Indicators and Epidemiological Profile.............................................. 9 Health Care Financing and User Fees ....................................................................... 11 3. Data and Descriptive Statistics on Illness and Health-Seeking Behavior..................... 14 The Data..................................................................................................................... 14 The Household Survey....................................................................................... 14 Descriptive Statistics: Health and Health Care.......................................................... 16 Reporting of Illness ............................................................................................ 16 The Decision to Seek Care................................................................................. 21 Choice of Health Care Provider......................................................................... 24 4. Methodology................................................................................................................. 31 The Theoretical Framework ...................................................................................... 31 Empirical Specification of Health Care Demand ...................................................... 33 Issues in Estimation of Health Care Demand ............................................................ 39 Sample Selection................................................................................................ 39 Functional Form................................................................................................. 43 Sample Design and Estimation Technique......................................................... 45 Variables in Estimation.............................................................................................. 47 The Dependent Variable: Provider Choice ........................................................ 47 Independent Variables........................................................................................ 47 5. Results........................................................................................................................... 55 Model Specification................................................................................................... 55 Interpretation of Results ............................................................................................ 57 The Effect of Individual and Household Characteristics........................................... 60 v Age ..................................................................................................................... 60 Gender ................................................................................................................ 61 Education and Literacy....................................................................................... 61 Income................................................................................................................ 63 Symptoms ........................................................................................................... 65 Dwelling and Household Characteristics ........................................................... 66 The Effect of Community Characteristics ................................................................. 67 The Effect of Travel Time and Price ......................................................................... 69 Policy Simulations ..................................................................................................... 71 6. Discussion and Conclusions ......................................................................................... 75 Appendix Tables ............................................................................................................... 79 References......................................................................................................................... 86 TABLES 1 Selected socioeconomic indicators ..............................................................................10 2 Population composition and reporting of illness, by province ....................................17 3 Reporting of illness in rural households ......................................................................18 4 Reporting of illness, by age category (rural households) ............................................18 5 Type of illness of those reporting illness in month prior to survey.............................20 6 The decision to seek care .............................................................................................22 7 The decision to seek care, by age category (rural households)....................................22 8 Health-seeking behavior, by type of illness.................................................................23 9 Choice of health care provider.....................................................................................27 10 Payment, travel time, and waiting time, by type of practitioner (rural).......................29 11 Own price elasticities, by income quintile...................................................................71 vi APPENDIX TABLES 12 Definition of variables in estimation............................................................................80 13 Description of variables in estimation (rural subsample) ............................................81 14 Description of variables in estimation (subsample of rural and ill).............................82 15 Estimation results (standard coefficients)....................................................................83 16 Estimation results (marginal effects) ...........................................................................84 17 Results: Wald test.........................................................................................................85 FIGURES 1 Mean predicted probabilities and
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