Please use this identifier to cite or link to this item: http://hdl.handle.net/11718/21288
Title: Underlying determinants of health provider choice in urban slums: results from a discrete choice experiment in Ahmedabad, India
Authors: Jaiswal, Anand Kumar
Pavlova, Milena
Cernauskas, Vilius
Angeli, Federica
Keywords: Health provider choice;Urban slums;Health-seeking behaviour;Discrete choice experiment;Bottom of the pyramid
Issue Date: Jun-2018
Publisher: BMC Health Services Research
Abstract: Background: Severe underutilization of healthcare facilities and lack of timely, affordable and effective access to healthcare services in resource-constrained, bottom of pyramid (BoP) settings are well-known issues, which foster a negative cycle of poor health outcomes, catastrophic health expenditures and poverty. Understanding BoP patients’ healthcare choices is vital to inform policymakers’ effective resource allocation and improve population health and livelihood in these areas. This paper examines the factors affecting the choice of health care provider in low-income settings, specifically the urban slums in India. Method: A discrete choice experiment was carried out to elicit stated preferences of BoP populations. A total of 100 respondents were sampled using a multi-stage systemic random sampling of urban slums. Attributes were selected based on previous studies in developing countries, findings of a previous exploratory study in the study setting and qualitative interviews. Provider type and cost, distance to the facility, attitude of doctor and staff, appropriateness of care and familiarity with doctor were the attributes included in the study. A random effects logit regression was used to perform the analysis. Interaction effects were included to control for individual characteristics. Results: The relatively most valued attribute is appropriateness of care (β=3.4213, p = 0.00), followed by familiarity with the doctor (β=2.8497, p = 0.00) and attitude of the doctor and staff towards the patient (β=1.8132, p = 0.00). As expected, respondents prefer shorter distance (β= − 0.0722, p = 0.00) but the relatively low importance of the attribute distance to the facility indicate that respondents are willing to travel longer if any of the other statistically significant attributes are present. Also, significant socioeconomic differences in preferences were observed, especially with regard to the type of provider. Conclusion: The analyses did not reveal universal preferences for a provider type, but overall the traditional provider type is not well accepted. It also became evident that respondents valued appropriateness of care above other attributes. Despite the study limitations, the results have broader policy implications in the context of Indian government’s attempts to reduce high healthcare out-of-pocket expenditures and provide universal health coverage for its population. The government’s attempt to emphasize the focus on traditional providers should be carefully reconsidered.
Description: BMC Health Serv Res. 2018; 18: 473. Published online 2018 Jun 19. doi: 10.1186/s12913-018-3264-x
URI: http://hdl.handle.net/11718/21288
Appears in Collections:Journal Articles

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