A matter of life and death: health care change in an Andean community.

Saraguro Indians in Ecuador employ optimizing techniques to select from several available health care resources. Ideational needs, rather than physical access, appear to impose the greatest influence on therapeutic choice. The influence of felt needs on health care is particularly apparent at birth and death. The community's new hospital provided free health care, but doctors failed to consider indigenous attitudes toward birth and death. The ideational cost of hospital care has made it an unacceptable alternative for residents.