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[Unpublished] 1998 Jul 1. 59,  p.This paper presents the results from a study designed to explore consumers' expectations for quality of family planning (FP) services and how it may influence demand in Egypt. The first section of the paper presents findings on women's and men's knowledge of reproductive health issues, including their definition of FP, the various FP methods, rumors and misinformation about these methods, attitudes and decision-making processes about FP practice and sources of information on FP. The findings provide a context for the types of services that Egyptian women and men may want or need. The second section covers the elements of quality that participants consider critical to good services and how the participants ranked these elements. The elements of quality are illustrated by descriptions of women's experiences with FP services as either positive or negative examples of each element. Finally, the third section presents results on the respondents' willingness to pay for high-quality services.
Bethesda, Maryland, Abt Associates, Health Financing and Sustainability Project, 1995 Aug. , xvii, 69 p. (USAID Contract No. DPE-5974-Z-00-9026-00)This technical report, prepared by USAID's Health Financing and Sustainability (HFS) project, reviews policy issues and constraints in developing countries. This report summarizes the nature and extent of HFS applied research activities in over 40 countries, synthesizes findings, and draws some conclusions and implications for policy and applied research. The following topics were the focus of HFS research: 1) quality of care and cost recovery, 2) protection of the poor under cost recovery, 3) mechanisms to promote demand, 4) provider incentives, 5) feasibility of social financing and insurance for low income populations, 6) public-private differences in efficiency, 7) private sector development, 8) private-public collaboration, and 9) reallocation of public sector spending. Over 40 applied research projects were conducted in mostly low income countries. Each project included a literature review of health service provision and costs, lessons learned, and field work. This report refers extensively to HFS research activities in Niger, Senegal, and the Central African Republic because of the large size and scope of research activities in these locations. Major findings are presented on the following topics: quality of care and its role in cost recovery and in government health services, protection of the poor under cost recovery, public sector reform, efficiency in service provision and differences between the public and private sectors, reallocation of public sectoring spending, expanding social financing, private sector potential for health care delivery in Africa, and the economic impact of malaria in Africa. It is concluded that the main quality of care problems were lack of drugs, medical supplies, and equipment and inappropriate medical practices. It is concluded that cost recovery may be able to cover the cost of essential drugs for treatment of ambulatory patients. Factors relating to the high rates of cost recovery are identified. Use of a fee or insurance system is considered to be dependent on the population's willingness to purchase premiums, managerial capability, and the means to invest insurance revenues. Willingness to pay appeared to be high among most population and income groups.
WORLD HEALTH FORUM. 1993; 14(2):123-4.Many national health services focus on the economically competent individual, rather than on society as a whole. They also tend to overlook the drain which the health economy represents on ecological systems. The injustices in health care and the global overconsumption of resources could eventually lead to equity of suffering. In the conflict, examined by Jean Martin, between the individual and the mass of people, patients have fought for the right to be at the center of health service endeavors. However, the notion that what is good for individuals and their families reflects sound health policy, is not a sufficient ethical principle for a fair and ecologically sound health policy. In recent times, market forces have come to be seen as a kind of panacea also in health care. However, if they are used in the heath field, the losers will continue to include the poor, the chronically ill, and the old. The balance between market forces and public responsibility for health care is economically crucial in the welfare state. People have always been obliged to accept that society takes precedence over individuals. The proposal to rely on enlightened despotism based on clear-sighted, incorruptible, and concerned citizens could well produce disaster. History shows that only democracy, despite its inadequacies, can provide tolerable solutions in the longterm. Change can only be achieved via citizens and their freely elected political leaders. There are positive signs, for instance, a growing acceptance of the need to eliminate inequity and abuse of the environment. Young people are increasingly aware that overpopulation and pollution are a threat to their lives. The factors of overwhelming significance are overpopulation and overconsumption, both of which will have to be reduced in the world's resource balance.
Household demand for health care in El Salvador. Volume II: determinants of household demand for curative ambulatory medical care.
Arlington, Virginia, John Snow, Inc. [JSI], Resources for Child Health Project [REACH], 1990 Feb. viii, 70 p. (USAID Contract No. DPE-5927-C-00-5068-00)The results of a study designed to explain consumer behavior with regard to the consumption of curative ambulatory health services provided by doctors in El Salvador, paying close attention to behavioral differences among urban and rural populations, are reported. The study relied on data collected through a survey of 13, 896 people in 2885 households in San Salvador, other urban areas, and rural areas. In order to identify demand determinants, the effect on health care demand of individual characteristics (e.g., gender, education, and income), and as well as provider characteristics (e.g., price, travel time, and waiting time) were measured. Health providers were categorized into 3 groups: 1) those associated with the Ministry of Health (MOH); 2) those associated with the El Salvador Social Security Institute (ISSS); and 3) private health care providers, whether for-profit or nonprofit. Following a summary and introduction, section III describes the study goals and methodology. Section IV reports the findings on health care utilization patterns, while section V contains the findings on the determinants of health care demand. Section VI discusses the policy implication of the study. 53% of those interviewed reported a self-perceived health problem during the survey's 2-week recall period, but only 14.9% sought curative ambulatory care. Of those who sought care, 81% saw a doctor. Demand for ambulatory care was highest in San Salvador and lowest in rural areas. Differences between the 2 groups were attributed to factors such as education, income, and traveling distances. The study also revealed that the population perceives MOH services as being of very poor quality, while private for-profit providers are viewed as rendering the highest quality services.
[Unpublished] 1985. Presented at the Annual Meeting of the Population Association of America, Boston, Massachusetts, March 28-30, 1985. Also published in: Economic Development and Cultural Change 34(4):755-82. 1986 Jul. 26,  p.Mortality is assumed to be strongly reduced by medical care, however, the effects of medical services on health are often underestimated because some of the same factors which lead to an increased demand for primary health care (PHC) services are also associated with increased morbidity and mortality. Consequently, understanding the determinants of the demand for medical services is important for evaluating health outcomes. This paper estimates the parameters of a simple model of the demand for health services using data from the Bicol Multipurpose Survey data from the Philippines. The parameters of the demand for key components of PHC--outpatient, prenatal, delivery, well-child, and infant immunizations--are estimated. Findings suggest that the quality of the care may be very important, but that economic factors as deterrents to using medical care--inaccessibility, cash costs, and lack of income--may not be of paramount importance. Finally, it is shown that the provision of free services in rural areas may not insure that the services reach the poorest people. (author's modified)