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Healthcare utilization, bypass, and multiple visits: the case of Bhutan

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  • Kannika Damrongplasit

    (Chulalongkorn University)

  • Tshering Wangdi

    (Ministry of Health)

Abstract

This paper uses the Bhutan Living Standards Survey 2012 to assess factors that affect the decision to use outpatient care when ill, outpatient utilization choice, and bypassing decision. Our attention is placed on geographical factors because of the unique geographical landscape in Bhutan, which may act as an important barrier for access to care in the country. We further analyze the pattern of multiple healthcare visits of individuals with the same health symptom. The methods employed for this study consist of binary logit and multinomial logit regressions as well as descriptive statistical approach. The results show that living in rural area, longer travel time, and residing in remote area reduce the chance of receiving formal care when ill, and among those who get formal treatment, these factors lead to higher tendency of visiting primary healthcare facilities and less propensity of getting care from secondary and tertiary providers. We also find that people with lower economic status have less access to care than their richer counterparts. By investigating the pattern of multiple outpatient visits, our analysis reveals incidence of bypassing primary care to higher level of care in Bhutan. There is also evidence of moving up to higher level of care during subsequent visits but in general people are very persistent in their provider choice.

Suggested Citation

  • 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.
  • Handle: RePEc:kap:ijhcfe:v:17:y:2017:i:1:d:10.1007_s10754-016-9194-4
    DOI: 10.1007/s10754-016-9194-4
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    References listed on IDEAS

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    1. Morey, Edward R. & Sharma, Vijaya R. & Mills, Anne, 2003. "Willingness to pay and determinants of choice for improved malaria treatment in rural Nepal," Social Science & Medicine, Elsevier, vol. 57(1), pages 155-165, July.
    2. Akin, John S. & Guilkey, David K. & Hazel?Denton, E., 1995. "Quality of services and demand for health care in Nigeria: A multinomial probit estimation," Social Science & Medicine, Elsevier, vol. 40(11), pages 1527-1537, June.
    3. Erlyana, Erlyana & Damrongplasit, Kannika Kampanya & Melnick, Glenn, 2011. "Expanding health insurance to increase health care utilization: Will it have different effects in rural vs. urban areas?," Health Policy, Elsevier, vol. 100(2), pages 273-281.
    4. Akin, John S & Griffin, Charles C & Guilkey, David K & Popkin, Barry M, 1986. "The Demand for Primary Health Care Services in the Bicol Region of the Philippines," Economic Development and Cultural Change, University of Chicago Press, vol. 34(4), pages 755-782, July.
    5. 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.
    6. Bijan J. Borah, 2006. "A mixed logit model of health care provider choice: analysis of NSS data for rural India," Health Economics, John Wiley & Sons, Ltd., vol. 15(9), pages 915-932, September.
    7. Dor, Avi & Gertler, Paul & van der Gaag, Jacques, 1987. "Non-price rationing and the choice of medical care providers in rural Cote d'Ivoire," Journal of Health Economics, Elsevier, vol. 6(4), pages 291-304, December.
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    Cited by:

    1. Richard Agbanyo & James Atta Peprah, 2021. "National health insurance and the choice of delivery facility among expectant mothers in Ghana," International Journal of Health Economics and Management, Springer, vol. 21(1), pages 27-49, March.
    2. Herberholz, Chantal & Phuntsho, Sonam, 2021. "Medical, transportation and spiritual out-of-pocket health expenditure on outpatient and inpatient visits in Bhutan," Social Science & Medicine, Elsevier, vol. 273(C).
    3. Herberholz, Chantal & Phuntsho, Sonam, 2018. "Social capital, outpatient care utilization and choice between different levels of health facilities in rural and urban areas of Bhutan," Social Science & Medicine, Elsevier, vol. 211(C), pages 102-113.

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    More about this item

    Keywords

    Healthcare utilization; Bypass; Travel time; Multiple visits; Multinomial logit model; Bhutan;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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