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Journal of African Economies Advance Access published online on June 23, 2005
Journal of African Economies, doi:10.1093/jae/eji015
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© The author 2005. Published by Oxford University Press on behalf of the Centre for the Study of African Economies. All rights reserved. For permissions, please email: journals.permissions@oupjournals.org

Article

The Utilisation of Curative Healthcare in Mozambique: Does Income Matter?

Magnus Lindelow 1 1

1 The World Bank, Centre for Study of African Economies, Oxford University


  Abstract

In Mozambique, easily treatable diseases such as malaria, diarrhoea and respiratory infections contribute to a heavy burden of disease. Notwithstanding efforts by the Mozambican government to promote access to healthcare, many who could benefit from simple, cost-effective healthcare services do not currently receive treatment. Moreover, it is known that the utilisation of health services varies considerably across spatial domains and socio-economic groups. This paper is concerned with understanding the determinants of utilisation of curative health services, paying particular attention to the role of income. It provides a broad analytical framework for analysing both the binary decision to seek formal healthcare in the event of illness, and the multinomial choice of healthcare provider. The results show that income is a relatively unimportant determinant of healthcare choices in Mozambique. Instead, other factors, in particular education and physical access, are more important. Moreover, unlike in some studies, own (time) price elasticity does not vary notably with income. At a methodological level, the analysis shows that the general conclusions are robust to a number of estimation issues that are rarely addressed explicitly in the analysis of healthcare choices, including sample selection, the potential endogeneity of consumption and cluster-level unobservables. For the analysis of provider choice, the paper demonstrates the merits of a ‘flexible’ behavioural model. In particular, the paper rejects some of the restrictions of the standard model of provider choice, and shows that both the level of the price elasticity and the extent to which the elasticity varies with income is sensitive to the empirical specification.

1I am grateful to the National Statistics Institute (INE) in Mozambique for granting me permission to use the 1996/97 Household Survey. Additional data were kindly provided by the Swiss Development Cooperation (Maputo). I am particularly grateful to Isabel Soares, Enrico Pavignani and Amelia Cumbi for their assistance in interpreting the data and providing valuable background information. Some of the research on which this paper is based was carried out as a component of an IFPRI/Ministry of Planning and Finance project (Policy Analysis and Training for Poverty Reduction in Mozambique). I am grateful to Ken Simler for the opportunity to participate in this work, and for his support and suggestions. I have also benefited from comments and suggestions from Marcel Fafchamps, Pieter Serneels and anonymous reviewers. Any remaining mistakes are my own responsibility. Financial support from Jan Wallanders and Tom Hedelius' Foundation for Research in the Social Sciences is gratefully acknowledged.


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