Quality of Medical Care and Choice of Medical Treatment in Kenya: An Empirical Analysis

Underutilization of medical facilities in African countries is widely believed to be a result of consumer disappointments with quality of care. This paper uses data from a randomized household survey, enriched with exogenous information on health facility attributes, to examine more deeply the quality factor in health care demand in rural Kenya. We find that broad availability of drugs in a medical facility is positively related to medical care use. Contrary to intuitive expectations, lack of prescription drugs is also positively related to medical care demand, while lack of aspirin reduces demand. We explain this counter-intuitive result by noting that any measure of availability of a consumable input is evidence of both demand and supply. Demand may be positively correlated with lack of drugs, for example, precisely because there is excess demand for available supplies. The results indicate the importance of selecting truly exogenous indicators of service quality for demand analysis. We also find that health care demand decreases with user fees and with greater distance to the provider, but increases with income. Gender is not a significant determinant of the choice of medical care in this dataset-whether considered separately or interacted with service variables.