Demand for health care services in Uganda: Implications for poverty reduction

Kasirye, Ibrahim and Ssewanyana, Sarah and Nabyonga, Juliet and Lawson, David (2004): Demand for health care services in Uganda: Implications for poverty reduction.

Abstract

Using the 2002/03 Uganda National Household Survey data we empirically examine the nature and determinants of individuals’ decisions to seek care on condition of illness reporting. The major findings include: first, cost of care is regressive and substantially reduces the health care utilization for any formal provider by the poorer individuals after 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 of care, other factors, in particular education and physical access proxied by distance to the facilities are important determinants of health care utilization.

• Item Type: MPRA Paper
• Language: English
• Subjects: I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy ; Regulation ; Public Health

References

Appleton, S. (2001a). Poverty in Uganda Preliminary Findings from the UNHS, Mimeo, University of Nottingham, United Kingdom.

_____, (2001b). Poverty Reduction During Growth The Case of Uganda 1992- 2000, Mimeo, University of Nottingham, United Kingdom.

______, (1995). “The interaction between poverty and gender in human capital accumulation: the case of the primary leaving exam in the Côte d'Ivoire" Journal of African Economies, 4(2): 192-224.

Appleton, S. and S. Ssewanyana (2003). Poverty analysis in Uganda, Economic Policy Research Centre, Kampala, Mimeo.

Akin, J.S., C. Griffin, D.K Guilkey., and B.M Popkin (1986). “The Demand for Primary Health services in the Bicol Region of the Philippines”. Economic Development and Cultural Change, 34(4): 755-782.

Akin, J.S., D.K. Guilkey and E. H. Denton (1995). “Quality of services and demand foe health care in Nigeria: A Multinomial Probit Estimation”. Social Science and Medicine, 40(11): 1526-1537.

Akin, J., D. Guilkey, P. Hutchinson and M. McIntosh, (1998). “Price elasticities of demand for curative health case with control for sample selectivity on endogenous illness: An analysis for Sri Lanka.”, Health Economics, 7(6): 509-31.

Asiimwe, D., F. Mwesigye., B. McPake and P. Striefland (1996). “Informal Markets and Formal Health Financing Policy.” Makerere Institute of Social Research, Kampala; Uganda Ministry of Health, Entebbe; London School of Hygiene and Tropical Medicine, London; and Royal Tropical Institute, Amsterdam.

Audibert M. and J. Mathonnat (2000). “Cost recovery in Mauritania initial lessons”. Health Policy and Planning, 15(1): 66-75.

Balabanova D. and M. McKee. (2002) “Understanding informal payments for health care: the example of Bulgaria”. Health Policy, 62(3): 243 - incomplete

Battest, G.E. (1997). “A note of the estimation of Cobb-Douglas production functions when some explanatory variables have zero values”, Journal of Agricultural Economics, 48(2): 250-52.

Benefo, K. and P.T. Shultz. (1994). “Determinants of fertility and child mortality in Cote d’Ivoire and Ghana”. Living Standard Measurement study Working paper. Washington, DC. The World Bank.

Bennet, S. (1989) “The impact of the increase in User Fees; A preliminary Investigation”. Lesotho Epidemiological Bulletin. incomplete

Bethune, X., S. Alfani. and J.P. Lahaye. (1989). “The influence of an abrupt Price Increase on Health services utilisation Evidence from Zaire”, Health Policy and Planning, 4: 76-81.

Castrol-Leal F., J. Dayton., L. Demery. and K. Mehra. (2000). “Public spending on health care in Africa do the poor benefit”. Bulletin of the World health Organisation. 78: . incomplete

Collins. D., J.D. Quick, S.N Musau, D. Kraushaar, and I.M Hussein. (1996) “The fall and rise of cost sharing in Kenya: the impact of phased implementation”. Health Policy and Planning. 11(1): 52-63.

Creese, A.L. (1991). “User charges for health care: A review of recent experiences.” Health policy and planning. 6(4): 309 –319.

Deinenger, K and P. Mpuga (2003). “Has abolition of healthy user fees improved the Welfare of vulnerable groups? Evidence from Uganda”. Paper presented at 2002/2003 Uganda National Household Survey Dissemination Workshop.

Diop, F., V. Seshamani. and C. Mulenga. (1998) Household seeking behaviour, Technical report No. 20 Bethesda MD: Partnerships for Health Reform, Abt, Associates, Inc.

Dor, A. and J. van der Gaag. (1993) “ Quantity Rationing and the demand of adults for medical care in Rural Cote d Ivoire” in A. Mills and K. Lee (eds) Health Economic Research in Developing Countries. pp. 193-213. Oxford, Oxford University Press.

Dow, W. H. (1996). “Unconditional demand for health care in Cote dÍvoire: Does selection of health status matter?” Living Standards Measurement Study Working Paper No. 127.

Ellis, R.P., D.K. McInnnes. and E.H. Stephenson. (1994) “Inpatient and Outpatient Health Care Demand in Cairo, Egypt”. Health Economics Vol incomplete.: 183-200. Fatima, J. (2002) “Health service utilisation and its determinants Prenatal care in Ecuador”. DfID Sexual and Reproductive Health programme. incomplete

Gertler, P., L. Locay. and W. Sanderson (1987). “Are user fees regressive? The welfare implications of Health Care Financing Proposals in Peru” Journal of Econometrics 36: 67-88.

Glick, P., J. Razafindravanona., I. Randretsa. (2000). “Education and Health services in Madagascar: Utilization and Demand determinants.” Cornell Food and Nutrition Policy Program Working Paper No. 107. Cornell University Ithaca New York.

Glison, L., D. Kalyalya, F. Kuchler, S. lake, H. Oranga and M. Ouendo, (2000). “The equity impacts of community financing activities in three African countries”. International Journal of health planning and management. 15: 291– 317.

Hallman, K. (1999). “Child health acre demand in a developing country Unconditional estimates from the Philippines”. IFPRI Food Consumption and Nutritional Division. Discussion Paper. No. 70.

Hutchinson, P. (2001). “Combating Illness” in R. Reinikka and P. Collier (eds) Uganda’s Recovery - The Role of Farms, Firms and Government’, Fountain Publishers, Kampala.

_____, (1999). “Health care in Uganda; selected issues”. World Bank discussion paper No. 404.

Jitta J. (1998) “Quality of care in Uganda health services” in Health care systems in Africa. University of Copenhagen and the Enreca Health Network Copenhagen, incomplete 35-47.

Juarez, F. (2002) “Health service utilisation and its determinants Prenatal Care in Ecuador”. Working Paper DfiD Sexual and Reproductive Program.

Karamagi, H. (2000) "Trends of health service utilization in government health units". Uganda Health Bulletin. 7(1): 48-52.

Karanja J. M., H. Gerald and M. Segall, (1995) “Impact of user charges on Vulnerable groups: the case of Kibwezi in rural Kenya”. Social Science and medicine, 41(6): 829-835.

Kivumbi, (2000) Implementation of waivers and fee exemptions in Uganda. incomplete

Lavy, V. and J.M. Quigley. (1993). “Willingness to pay for the quantity and intensity of Medical Care Low-income Households in Ghana”. World bank Living Standards Measurement Study working paper No. 94.

Lindelow M. (2002) “Health care demand in rural Mozambique Evidence from the 1996/97 household survey”. IFPRI Food Consumption and Nutritional Division. Discussion Paper. No. 126.

Lindelow, M., R.Reinikka. and J.Svensson (2003). “Health Care on the Frontlines: Survey Evidence on Public and Private Providers in Uganda”. World Bank Africa Region Human Development Working Series No. 37

Makinen, M. (1999). “Conventional wisdom and Empirical data on Inequalities in Morbidity, Use of services and Health Expenditures”. PHR, USAID, Washington, D.C. Mbanefoh and Soyibo, 1994

McPake, B. (1993). “User charges for health services in developing countries: A review of economic literature”. Social science and medicine Vol 36 No 11, pp 1393 –1395.

Mwabu G., J. Mwanzia. and W. Liamblia. (1995) “User Charges in government health facilities in Kenya: effect on attendance and revenue”. Health policy and Planning 10(2): 164-170.

Mwabu, G., M. Ainsworth. and A. Nyamete. (1993). “Quality of medical care and choice of medical treatment in Kenya”. The Journal of Human Resources, 28(4): 838 – 862.

Mwesigye, F. (2002) “Effects of abolition of cost sharing”. A Commissioned study by the Uganda National NGO-Forum. ______, (1996) “Effects of User charges on Quality of curative services in Rural Health Units in Uganda.” Ministry of Health, Health Planning Department, Entebbe. Ocom, F. (1997). Quality of Care in Mukono Dissertation for a Masters in Public Health Makerere University, Kampala.

Odaga and Everd, (2003) “Faithfulness to the mission: Accelerated reduction in user Fees and Increased utilisation of the poor to our facilities”. Commissioned study by the Uganda catholic medical bureau and Uganda protestant medical bureau.

Okello, D.O., R. Lubanga, D. Guwatudde, and A. Sebina-Zziwa. (1998) “The Challenge to Restoring Basic health Care in Uganda.” Social Science and Medicine, 46(10): 13-21.

Government of Uganda (2003a). Health sector Strategic Plan Mid Term Review Report. Ministry of Health, Kampala.

_____, (2003b). Annual Health sector performance Report. Ministry of Health, Kampala.

_____, (2003c). “The Health Sector PEAP Review Paper” presented by the Ministry of Health at the National Stakeholders workshop on PEAP revision and Budget Framework 2004/2005-2006-2007.

_____, (2003d). Uganda Participatory Poverty Assessment Report. Ministry of Finance Planning and Economic Development, Kampala.

_____, (2002a). Public expenditure Review 2001 Report on the Progress and Challenges in Budget Reforms. Ministry of Finance Planning and Economic Development, Kampala.

_____, (2002b). “Background to the Budget 2002/2003”. Ministry of Finance Planning and Economic Development, Kampala.

_____, (2002c) “Preliminary report of the 2002 Population and Housing Census”. Uganda Bureau of Statistics, Entebbe.

_____, (2002d). Statistical abstract. Ministry of Health, Kampala.

_____, (2001a) Uganda Demographic and Health Survey 2000/2001 Uganda Bureau of Statistics, Entebbe.

_____, (2001b). “Background to the Budget 2001/2002”. Ministry of Finance Planning and Economic Development, Kampala.

_____, (2001c) Statistical abstract 2001 Uganda Bureau of Statistics, Entebbe.

_____, (2000a) Uganda National household survey 1999/2000. Uganda Bureau of Statistics, Entebbe.

_____, (2000b) Health Facility Survey 1999/2000. Ministry of Health, Kampala.

_____, (1999a). Uganda Participatory Poverty Assessment Report. Ministry of Finance Planning and Economic Development, Kampala.

_____, (1999b). Health Sector Strategic Plan. Ministry of Health, Kampala.

_____, (1997a) Social Dimension of Adjustment Monitoring Surveys 1993–94 and 1995–96. Ministry of Finance Planning and Economic Development, Statistics Department, Kampala.

_____, (1997b) Poverty Eradication action Plan Ministry of Finance Planning and Economic Development, Kampala.

_____, (1996). Inventory of health services in Uganda. Ministry of Health, Kampala.

_____, (1995a). Burden of disease study 1995/96 Ministry of Health, Kampala.

_____, (1995b). Uganda Demographic and Health Survey 1995 Ministry of Finance Planning and Economic Development, Statistics Department, Entebbe and Macro International, Calverton, Maryland.

_____, (1993). Inventory of health services in Uganda. Ministry of Health, Kampala.

_____, (1989) Uganda Demographic and Health Survey 1989 Ministry of Finance Planning and Economic Development, Statistics Department, Entebbe and Macro International, Calverton, Maryland.

Sahn. E. D., S. Younger, and G. Genicot. (2003). “The Demand for Health Services in Rural Tanzania”. Oxford Bulletin of Economics and Statistics, 65(2): 241-260. Train, K. E. (2003). Discrete Choice Methods with Simulation, Cambridge, Cambridge University Press.

United Nations Development Programme (2003). Human Development Report. New York: Oxford University Press.

_____, (2000). Uganda Human Development Report. New York: Oxford University Press.

_____, (1991). Human Development Report. New York: Oxford University Press.

Van Der Geest, S., M. Macwagn’gi., J.Kamwanga., D.Mulikelela., A. Mazimba. and M. Mwangelwa. (2000), “User fee and drugs: What did the Health Reforms in Zambia achieve?” Health Policy and Planning, 15(1): 59-65.

Waddington, C. and K. Enyimayew, (1989). “A price to Pay: The Impact of User Charges in Ashanti-Akim District, Ghana”, International Journal of Health Planning and Management, Vol.4. incomplete

Wilkinson, D., E. Gouws. M. Sach., S. Salim., and K. Abdool. (2001). “Effect of removing user fee on attendance for curative and preventive primary health care services in rural South Africa”. Bulletin of the World Health Organisation, 79(1): incomplete

Wills, C. (1993). “Means testing in cost recovery of health Services Phase 1 Review of concepts and Literature, and preliminary Field work design.” Major applied Research Report No. 7. HFS Project. Abt Associates Inc., Bethesda, MD Wong, E., B. Porkin., D. Guilkey. and S. Akin (1987) “Accessibility, quality of care and prenatal care use in the Philippines 1987”. Social Science and Medicine, 24(11): 928 – 943.

World Bank. (1993). World Development Report. Investing in Health. New York, Oxford University Press.

World Health Organisation (2002) “Report on study on effects of abolition of cost sharing in Uganda”. In collaboration with Ministry of Health, Kampala.

_____, (2001) Macro Economics and Health: Investing in health for economic development.

_____, (2000) “ Evaluation of the Bamako Initiative Scheme in Rukungiri District”. In collaboration with Ministry of Health, Kampala.

Yoder, R.A., (1989) “Are people willing and able to pay for health services?” Social science and Medicine. Vol. 29. No. 1:35-42.