RAND Corporation, Pittsburgh, PA, United States of America.
RAND Corporation, Arlington, VA, United States of America.
PLoS One. 2019 Feb 7;14(2):e0211500. doi: 10.1371/journal.pone.0211500. eCollection 2019.
This paper examines the association between health facility quality, subjective perceptions, and utilization of obstetric care. We draw on unique survey data from Nigeria describing the quality of care at rural primary health care facilities and the utilization of obstetric care by households in the service areas of these facilities. Constructing a quality index using the detailed survey data, we show that facility quality is positively related to perceptions of quality and utilization. Disaggregating quality into structural, process and outcome dimensions, we find a consistently strong relationship only between utilization and structural measures of quality. The results suggest that efforts to improve quality may involve a trade-off between investing in dimensions that are more easily observed by households, which will influence utilization, and investing in dimensions that are more closely related to outcomes.
本文考察了医疗机构质量、主观认知与产科保健利用之间的关系。我们利用尼日利亚独特的调查数据，描述了农村初级卫生保健机构的医疗服务质量以及这些机构服务区域内的家庭对产科保健的利用情况。利用详细的调查数据构建了一个质量指数，我们发现医疗机构的质量与人们对其质量的认知和利用呈正相关。将质量分解为结构、过程和结果维度，我们发现只有结构质量测量与利用之间存在一致的强关系。结果表明，提高质量的努力可能需要在家庭更容易观察到的维度上进行投资，这将影响利用，以及在与结果更密切相关的维度上进行投资之间进行权衡。
