Hotchkiss D R
Department of International Health and Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112-2737, USA.
Soc Sci Med. 1998 Jan;46(2):227-42. doi: 10.1016/s0277-9536(97)00152-4.
This paper examines the tradeoff that consumers make between price and quality in the demand for health care. The analysis is based on data collected from both households and health care facilities in Cebu, Philippines. The availability of both types of data makes this one of only a handful of demand for health care studies that includes detailed information on both individual characteristics and facility attributes of all relevant alternatives. The developing country setting provides substantial variation in the type of facility chosen, ranging from home delivery aided only by friends and relatives at one extreme to modern private hospitals at the other end of the spectrum. The alternatives vary greatly in quality and price, making this an ideal context for examining the role of these variables in facility choice. The nested logit model specifications that are estimated contain price, travel time, and different combinations of quality measures, including the availability of medical supplies, practitioner training, service availability, facility size and crowdedness, and their interaction with individual characteristics. In addition, the sensitivity of the results to different choice-set definitions is analyzed. In particular, models that use conventional choice-set definitions that are based only on nominal status are compared with models that attempt to classify facilities into relatively homogeneous groups based on price and quality. The estimation results, which correct for the two-stage design of the household survey, indicate that facility crowding and practitioner training are significant determinants of consumer choice. The results also indicate that individual characteristics such as education of the woman interact in important ways with quality in influencing choice. For example, the availability of drugs is a significant determinant of facility choice for women with high levels of education, but not for others. In addition, the results support the hypothesis that price is a significant determinant for poor households, but not for other households. The model is used to conduct policy simulations designed to be informative to public officials interested in the effect of cost recovery schemes on utilization patterns. The simulations indicate that, when public facilities simultaneously increase user fees and the aspects of quality over which policy makers can exercise control in the short-run, the mean probability of using public facilities increases for both poor and non-poor households.
本文研究了消费者在医疗保健需求中在价格和质量之间所做的权衡。该分析基于从菲律宾宿务的家庭和医疗保健机构收集的数据。这两种类型数据的可得性使得本研究成为少数几个关于医疗保健需求的研究之一，这些研究包含了所有相关替代方案的个体特征和机构属性的详细信息。发展中国家的背景使得所选择的机构类型有很大差异，从一端仅由朋友和亲戚协助的家庭分娩到另一端的现代私立医院。这些替代方案在质量和价格上有很大差异，这使其成为研究这些变量在机构选择中作用的理想背景。所估计的嵌套逻辑模型规格包含价格、出行时间以及质量度量的不同组合，包括医疗用品的可得性、从业者培训、服务可得性、机构规模和拥挤程度，以及它们与个体特征的相互作用。此外，还分析了结果对不同选择集定义的敏感性。特别是，将使用仅基于名义状态的传统选择集定义的模型与试图根据价格和质量将机构分类为相对同质组的模型进行了比较。校正了家庭调查两阶段设计的估计结果表明，机构拥挤和从业者培训是消费者选择的重要决定因素。结果还表明，诸如女性教育程度等个体特征在影响选择时与质量以重要方式相互作用。例如，药品的可得性是高教育水平女性选择机构的重要决定因素，但对其他女性则不然。此外，结果支持以下假设：价格是贫困家庭的重要决定因素，但对其他家庭则不是。该模型用于进行政策模拟，旨在为对成本回收计划对使用模式的影响感兴趣的政府官员提供信息。模拟表明，当公共机构同时提高用户费用以及政策制定者在短期内可以控制的质量方面时，贫困家庭和非贫困家庭使用公共机构的平均概率都会增加。
