Gendered Barriers to Formal Health-Care Utilization: Modeling Health-Care Demand in a Low-Resource Setting

This paper develops a model of health-care demand to study health-care choices in resource-limited settings with poor health indicators, especially for women. Using data from rural Nigeria on individual illnesses and injuries as well as the entire portfolio of locally available providers, we estimate the effect of price, distance, and quality on access to care, focusing on the heterogeneous responses to these three factors by gender. We find that women are more price sensitive than men, in particular in households where they have low bargaining power, while being equally responsive to quality or distance. Using our model to simulate ex ante the effects of price interventions, we predict that a full price subsidy in public clinics would substantially increase both men’s and women’s access to formal care and almost eliminate the observed gender gap in formal health-care utilization. Subsidizing both public and private clinics only marginally improves overall access, but it fully eliminates the observed gender gap in addition to broadening the capacity of the health sector to respond to increased demand when public facilities have limited capacity.