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Health-care Facility Choice and the Phenomenon of Bypassing

Health-care Facility Choice and the Phenomenon of Bypassing Health policy-makers in developing countries are often disturbed and to a degree surprised by the phenomenon of the ill travelling past a free or subsidized local public clinic (or other public facility) to get to an alternative source of care at which they often pay a considerable amount for health care. That a person bypasses a facility is almost certainly indicative either of significant problems with the quality of care at the bypassed facility or of significantly better care at the alternative source of care chosen. When it is a poor person choosing to bypass a free public facility and pay for care further away, such action is especially bothersome to public policy-makers. This paper uses a unique data set, with a health facility survey in which all health facilities are identified, surveyed, and located geographically; and a household survey in which a sample of households from the same health district is also both surveyed and located geographically. The data are analyzed to examine patterns of health care choice related to the characteristics and locations of both the facilities and actual and potential clients. Rather than using the distance travelled or some other general choice of type of care variable as the dependent variable, we are able actually to analyze which specific facilities are bypassed and which chosen. The findings are instructive. That bypassing behaviour is not very different across income groups is certainly noteworthy, as is the fact that the more severely ill tend to bypass and to travel further for care than do the less severely ill. In multivariate analysis almost all characteristics of both providers and facilities are found to have the a priori expected relationships to facility choice. Prices tend to deter use, and improved quality of services to increase the likelihood of a facility being chosen. The answer to the bypassing dilemma seems to be for providers to provide as good quality care relative to the money charged (if any), as other, often further away, providers. © Oxford University Press 1999 « Previous | Next Article » Table of Contents This Article Health Policy Plan. (1999) 14 (2): 135-151. » Abstract Free Full Text (PDF) Free Classifications Articles Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Disclaimer Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Akin, J. S. Articles by Hutchinson, P. Search for related content PubMed PubMed citation Articles by Akin, J. S. Articles by Hutchinson, P. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue December 2015 30 (10) Alert me to new issues The Journal About this journal Publishers' Books for Review Recent E-Letters Rights & Permissions Dispatch date of the next issue We are mobile – find out more Journals Career Network Published in association with The London School of Hygiene and Tropical Medicine Impact factor: 3.470 5-Yr impact factor: 3.552 Editors-in-Chief Virginia Wiseman and Sandra Mounier-Jack View full editorial board For Authors Instructions to authors Online submission instructions Submit Now! Author Self Archiving Policy Open access options for authors visit Oxford Open This journal enables compliance with the NIH Public Access Policy Alerting Services Email table of contents Email Advance Access CiteTrack XML RSS feed Corporate Services Advertising sales Reprints Supplements var taxonomies = ("MED00860"); Most Most Read 'Doing' health policy analysis: methodological and conceptual reflections and challenges Surgical and anaesthetic capacity of hospitals in Malawi: key insights Calculating QALYs, comparing QALY and DALY calculations Constructing socio-economic status indices: how to use principal components analysis The role of community-based organizations in household ability to pay for health care in Kilifi District, Kenya » View all Most Read articles Most Cited Constructing socio-economic status indices: how to use principal components analysis Reforming the health sector in developing countries: the central role of policy analysis Overcoming barriers to health service access: influencing the demand side Measuring social capital within health surveys: key issues The terrain of health policy analysis in low and middle income countries: a review of published literature 1994-2007 » View all Most Cited articles Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department. 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Health-care Facility Choice and the Phenomenon of Bypassing

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Publisher
Oxford University Press
Copyright
Copyright © 2015 Oxford University Press
ISSN
0268-1080
eISSN
1460-2237
DOI
heapol;14/2/135
Publisher site
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Abstract

Health policy-makers in developing countries are often disturbed and to a degree surprised by the phenomenon of the ill travelling past a free or subsidized local public clinic (or other public facility) to get to an alternative source of care at which they often pay a considerable amount for health care. That a person bypasses a facility is almost certainly indicative either of significant problems with the quality of care at the bypassed facility or of significantly better care at the alternative source of care chosen. When it is a poor person choosing to bypass a free public facility and pay for care further away, such action is especially bothersome to public policy-makers. This paper uses a unique data set, with a health facility survey in which all health facilities are identified, surveyed, and located geographically; and a household survey in which a sample of households from the same health district is also both surveyed and located geographically. The data are analyzed to examine patterns of health care choice related to the characteristics and locations of both the facilities and actual and potential clients. Rather than using the distance travelled or some other general choice of type of care variable as the dependent variable, we are able actually to analyze which specific facilities are bypassed and which chosen. The findings are instructive. That bypassing behaviour is not very different across income groups is certainly noteworthy, as is the fact that the more severely ill tend to bypass and to travel further for care than do the less severely ill. In multivariate analysis almost all characteristics of both providers and facilities are found to have the a priori expected relationships to facility choice. Prices tend to deter use, and improved quality of services to increase the likelihood of a facility being chosen. The answer to the bypassing dilemma seems to be for providers to provide as good quality care relative to the money charged (if any), as other, often further away, providers. © Oxford University Press 1999 « Previous | Next Article » Table of Contents This Article Health Policy Plan. (1999) 14 (2): 135-151. » Abstract Free Full Text (PDF) Free Classifications Articles Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Disclaimer Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Akin, J. S. Articles by Hutchinson, P. Search for related content PubMed PubMed citation Articles by Akin, J. S. Articles by Hutchinson, P. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue December 2015 30 (10) Alert me to new issues The Journal About this journal Publishers' Books for Review Recent E-Letters Rights & Permissions Dispatch date of the next issue We are mobile – find out more Journals Career Network Published in association with The London School of Hygiene and Tropical Medicine Impact factor: 3.470 5-Yr impact factor: 3.552 Editors-in-Chief Virginia Wiseman and Sandra Mounier-Jack View full editorial board For Authors Instructions to authors Online submission instructions Submit Now! Author Self Archiving Policy Open access options for authors visit Oxford Open This journal enables compliance with the NIH Public Access Policy Alerting Services Email table of contents Email Advance Access CiteTrack XML RSS feed Corporate Services Advertising sales Reprints Supplements var taxonomies = ("MED00860"); Most Most Read 'Doing' health policy analysis: methodological and conceptual reflections and challenges Surgical and anaesthetic capacity of hospitals in Malawi: key insights Calculating QALYs, comparing QALY and DALY calculations Constructing socio-economic status indices: how to use principal components analysis The role of community-based organizations in household ability to pay for health care in Kilifi District, Kenya » View all Most Read articles Most Cited Constructing socio-economic status indices: how to use principal components analysis Reforming the health sector in developing countries: the central role of policy analysis Overcoming barriers to health service access: influencing the demand side Measuring social capital within health surveys: key issues The terrain of health policy analysis in low and middle income countries: a review of published literature 1994-2007 » View all Most Cited articles Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department. Online ISSN 1460-2237 - Print ISSN 0268-1080 Copyright © 2015 Oxford University Press Oxford Journals Oxford University Press Site Map Privacy Policy Cookie Policy Legal Notices Frequently Asked Questions Other Oxford University Press sites: Oxford University Press Oxford Journals China Oxford Journals Japan Academic & Professional books Children's & Schools Books Dictionaries & Reference Dictionary of National Biography Digital Reference English Language Teaching Higher Education Textbooks International Education Unit Law Medicine Music Online Products & Publishing Oxford Bibliographies Online Oxford Dictionaries Online Oxford English Dictionary Oxford Language Dictionaries Online Oxford Scholarship Online Reference Rights and Permissions Resources for Retailers & Wholesalers Resources for the Healthcare Industry Very Short Introductions World's Classics function fnc_onDomLoaded() { var query_context = getQueryContext(); PF_initOIUnderbar(query_context,":QS:default","","JRN"); PF_insertOIUnderbar(0); }; if (window.addEventListener) { window.addEventListener('load', fnc_onDomLoaded, false); } else if (window.attachEvent) { window.attachEvent('onload', fnc_onDomLoaded); } var gaJsHost = (("https:" == document.location.protocol) ? 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Journal

Health Policy and PlanningOxford University Press

Published: Jan 1, 1999

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