Volume 28, Number 4 (Fall) 1993
Mwabu, Germano, Martha Ainsworth, and Andrew Nyamete. 1993. "Quality of Medical Care and Choice of Medical Treatment in Kenya: An Empirical Analysis." Journal of Human Resources 28(4):838-862.
Underutilization of medical facilities in African countries is widely believed to be a result of consumer disappointments with quality of care. This paper uses data from a randomized household survey, enriched with exogenous information on health facility attributes, to examine more deeply the quality factor in health care demand in rural Kenya. We find that broad availability of drugs in a medical facility is positively related to medical care use. Contrary to intuitive expectations, lack of prescription drugs is also positively related to medical care demand, while lack of aspirin reduces demand. We explain this counter-intuitive result by noting that any measure of availability of a consumable input result is evidence of both demand and supply. Demand may be positively correlated with lack of drugs, for example, precisely because there is excess demand for available supplies. The results indicate the importance of selecting truly exogenous indicators of service quality for demand analysis. We also find that health care demand decreases with user fees and with greater distance to the provider, but increases with income. Gender is not a significant determinant of the choice of medical care in this dataset - whether considered separately or interacted with service variables.
Germano Mwabu is a professor of economics at Kenyatta University, Nairobi, Kenya; Martha Ainsworth and Andrew Nyamete are researchers in the Africa Technical Department, The World Bank. This study was sponsored by the Africa Regional Study on Health Finance, managed by the Population, Health, and Nutrition Division of the Africa Technical Department of the World Bank. The authors greatly appreciate the comments on earlier drafts made by Charles Griffin, Raylynn Oliver, Mark Rosenzweig, Paul Schultz, Robert Willis, and participants in seminars at the World Bank and at the Rockefeller Conference on Women's Human Capital and Development. Khadija Bah, Karol Brown, and Jim Shafer provided valued assistance in preparation of the current draft. This paper would never have been completed were it not for the kind and diligent assistance of Mrs. Annie Kihara, who was the critical "link" between the Nairobi and Washington researchers. However, the opinions expressed in this paper are those of the authors and do not reflect official positions of the World Bank or its members. The data used in this article can be obtained from June 1994 through June 1997 from the author at the following address: Professor Germano Mwabu, Kenyatta University, Department of Economics, P.O. Box 43844, Nairobi, Kenya.
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