The Demand for Medical Care: Evidence from Urban Areas in Bolivia
The Demand for Medical Care: Evidence from Urban Areas in Bolivia
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医疗保健需求：来自玻利维亚城市地区的证据
DOI：
10.1596/0-8213-3565-0
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发表时间：
1996
期刊：
影响因子：
--
通讯作者：
Masako Li
中科院分区：
文献类型：
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作者：
Masako Li
本研究分析了玻利维亚城市地区医疗服务需求的决定因素。它还研究了不同年龄、性别、种族和收入群体的成本回收和卫生服务使用之间可能的权衡。使用的数据来自 Encuesta Integrada de Hogares (EIH) 第三年的数据，这是一项由玻利维亚统计局和世界银行进行的多用途家庭调查。这些数据用于估计多项 Logit 模型和嵌套多项 Logit 模型（患者对医疗设施的选择）。这项研究的主要实证结果是，医疗需求对价格变化敏感，但价格弹性总体上很低。这一发现与其他国家的研究结果相当。此外，需求的价格弹性随着收入的增加而下降。对于儿童来说，价格弹性低于成人。价格弹性因种族或性别的不同而变化不大，但估计结果显示，讲艾马拉语的人（印度族群）更有可能照顾自己。可能存在文化障碍阻碍艾马拉语使用者寻求正规护理。结果还表明，收入和教育也是医疗需求的重要决定因素。对于孩子来说，母亲的教育远比父亲的影响更大。由于价格弹性如此之低，这表明玻利维亚政府有可能通过收取使用费来增加收入。如果额外收入不用于扩大初级卫生保健或提高质量，则对服务收取使用者费用可能不会大幅减少卫生部门的低效率和/或不平等。
This research analyzes the determinants of demand for medical services in urban areas of Bolivia. It also examines the possible trade-offs between cost recovery and the use of health services for different age, sex, ethnic, and income groups. The data used are from the third year of the Encuesta Integrada de Hogares (EIH), a multipurpose household survey conducted by the statistical office in Bolivia and the World Bank. The data are used to estimate a multinomial logit model, and a nested multinomial logit model (choice of medical facilities by patients). The main empirical result of this research is that the demand for medical care is responsive to changes in price, but price elasticities are, in general, very low. This finding is comparable to that of research for other countries. Moreover, the price elasticity of demand falls as income rises. For children, the price elasticities are lower than for adults. Price elasticities do not vary much by ethnic group or gender, but estimation results show that Aymara speakers (an Indian group) are more likely to care for themselves. Probably there are cultural barriers that prevent Aymara speakers from seeking formal care. The results also show that income and education are also important determinants of demand for medical care. For children, mother's education is far more influential than father's. Since price elasticities are so low, it suggests that there is potential for the Bolivian government to raise revenues by charging user fees. If additional revenues are not used to expand primary health care or to improve quality, imposing user charges on services may not substantially reduce inefficiency and/or inequity in the health sector.