Estimating the demand for preventive health services controlling for endogenous public sector resource allocations

• Main Author: Hutchinson, Paul Laurence
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01.01.2000
• Subjects: Bias; Decision making; Demand; Developing countries; Economics; Government spending; Health care; Health care expenditures; Health care management; Health insurance; Immunization; Insurance coverage; LDCs; Maternal & child health; Preventive medicine; Public health; Public policy; Public sector; Resource allocation; Womens health
• ISBN: 9780493015972; 0493015973

This dissertation examines the market for preventive health care services in the developing country of Uganda. It focuses both on individuals' decisions to use preventive services—childhood immunizations and prenatal care during pregnancies—and local health planners' decisions to allocate resources to these preventive health programs. The analysis extends the debate on the efficacy of public sector expenditure in developing countries, particularly in the context of decentralized provision of services, to examine the impacts of public sector preventive health care expenditures on both individual level demand and health outcomes. It also seeks to measure the impact of basic preventive care services on reducing the likelihood of the adverse events they are intended to prevent. Several estimators, including a semi-parametric discrete factor random effects estimator, are used to test and control for possible endogenous placement of government programs and possible endogenous individual preventive health care demand. Not controlling for these relationships may lead to biased estimates of the impacts of government expenditure and preventive health care. The analysis finds that district health planners rationally allocate resources to areas of greater epidemiological need. However, complementing existing literature, the analysis finds that these additional expenditures have little impact on health behaviors and health outcomes. At the individual level, significant protective effects on illness prevalence are found for children completing the schedule of basic childhood immunizations. Patterns of preventive health care demand are also examined.