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Bypassing health providers: The quest for better price and quality of health care in Chad

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  • Gauthier, Bernard
  • Wane, Waly

Abstract

This paper investigates individuals' bypassing behavior in the health sector in Chad and the determinants of individuals' facility choice. We introduce a new way for measuring bypassing which uses the patients' own knowledge of alternative health providers available to them, instead of assuming perfect information as previously done. We analyze how objective and perceived health care quality and prices impact patients' bypassing decisions. The analysis uses data from a health sector survey carried out in 2004 covering 281 primary health care centers and 1801 patients. We observe that income inequalities translate into health service inequalities. We find evidence of two distinct types of bypassing activities in Chad: (1) patients from low-income households bypass high quality facilities they cannot afford and go to low-quality facilities, and (2) rich individuals bypass low-quality facilities and aim for more expensive facilities which also offer a higher quality of care. These significant differences in patients' facility choices are observed across income groups as well as between rural and urban areas.

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  • Gauthier, Bernard & Wane, Waly, 2011. "Bypassing health providers: The quest for better price and quality of health care in Chad," Social Science & Medicine, Elsevier, vol. 73(4), pages 540-549, August.
    • Handle: RePEc:eee:socmed:v:73:y:2011:i:4:p:540-549
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    1. Bernard Gauthier & Waly Wane, 2009. "Leakage of Public Resources in the Health Sector: An Empirical Investigation of Chad †," Journal of African Economies, Centre for the Study of African Economies, vol. 18(1), pages 52-83, January.
    2. Leonard, Kenneth L, 2007. "Learning in Health Care: Evidence of Learning about Clinician Quality in Tanzania," Economic Development and Cultural Change, University of Chicago Press, vol. 55(3), pages 531-555, April.
    3. Leonard, Kenneth L., 2008. "Is patient satisfaction sensitive to changes in the quality of care? An exploitation of the Hawthorne effect," Journal of Health Economics, Elsevier, vol. 27(2), pages 444-459, March.
    4. Filmer, Deon & Hammer, Jeffrey S & Pritchett, Lant H, 2000. "Weak Links in the Chain: A Diagnosis of Health Policy in Poor Countries," The World Bank Research Observer, World Bank, vol. 15(2), pages 199-224, August.
    5. Kenneth L. Leonard & Gilbert R. Mliga & Damen Haile Mariam, 2002. "Bypassing Health Centres in Tanzania: Revealed Preferences for Quality," Journal of African Economies, Centre for the Study of African Economies, vol. 11(4), pages 441-471, December.
    6. Germano Mwabu & Martha Ainsworth & Andrew Nyamete, 1993. "Quality of Medical Care and Choice of Medical Treatment in Kenya: An Empirical Analysis," Journal of Human Resources, University of Wisconsin Press, vol. 28(4), pages 838-862.
    7. World Bank, 2010. "World Development Indicators 2010," World Bank Publications - Books, The World Bank Group, number 4373.
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    Cited by:

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    2. Patrick Guillaumont & Laurent Wagner, 2014. "Aid Effectiveness for Poverty Reduction: Lessons from Cross‑country Analyses, with a Special Focus on Vulnerable Countries," Revue d’économie du développement, De Boeck Université, vol. 22(HS01), pages 217-261.
    3. Patrick Guillaumont, 2011. "Aid effectiveness for poverty reduction:macroeconomic overview and emerging issues," CERDI Working papers halshs-00554285, HAL.
    4. Kannika Damrongplasit & Tshering Wangdi, 2017. "Healthcare utilization, bypass, and multiple visits: the case of Bhutan," International Journal of Health Economics and Management, Springer, vol. 17(1), pages 51-81, March.
    5. Lewis, Maureen & Pettersson, Gunilla, 2009. "Governance in health care delivery : raising performance," Policy Research Working Paper Series 5074, The World Bank.
    6. Idrissa Beogo & Chieh-Yu Liu & Yiing-Jenq Chou & Chuan-Yu Chen & Nicole Huang, 2014. "Health-Care-Seeking Patterns in the Emerging Private Sector in Burkina Faso: A Population-Based Study of Urban Adult Residents in Ouagadougou," PLOS ONE, Public Library of Science, vol. 9(5), pages 1-11, May.
    7. Lourdes Diaz Olvera & Didier Plat & Pascal Pochet, 2011. "Se déplacer pour se soigner. Pratiques et obstacles à Conakry et Douala," Post-Print halshs-00733353, HAL.
    8. Saleh Babazadeh & Philip Anglewicz & Janna M Wisniewski & Patrick K Kayembe & Julie Hernandez & Jane T Bertrand, 2020. "The influence of health facility-level access measures on modern contraceptive use in Kinshasa, DRC," PLOS ONE, Public Library of Science, vol. 15(7), pages 1-20, July.
    9. Abdullah Alibrahim & Shinyi Wu, 2018. "An agent-based simulation model of patient choice of health care providers in accountable care organizations," Health Care Management Science, Springer, vol. 21(1), pages 131-143, March.
    10. Tripathi, Shruti, 2018. "Hospital choice in a government funded health insurance scheme: Evidence from Andhra Pradesh," MPRA Paper 87159, University Library of Munich, Germany.
    11. Bezu, Sosina & Binyaruka, Peter & Mæstad, Ottar & Somville, Vincent, 2021. "Pay-for-performance reduces bypassing of health facilities: Evidence from Tanzania," Social Science & Medicine, Elsevier, vol. 268(C).
    12. Thorsen, Maggie L. & Harris, Sean & Palacios, Janelle F. & McGarvey, Ronald G. & Thorsen, Andreas, 2023. "American Indians travel great distances for obstetrical care: Examining rural and racial disparities," Social Science & Medicine, Elsevier, vol. 325(C).
    13. Ikuo Ishibashi & Noriaki Matsushima, 2012. "Should Public Sectors Be Complements of Private Sectors?," Journal of Institutional and Theoretical Economics (JITE), Mohr Siebeck, Tübingen, vol. 168(4), pages 712-730, December.

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