Underlying determinants of health provider choice in urban slums

Results from a discrete choice experiment in Ahmedabad, India

Vilius Cernauskas, F. Angeli, Anand Kumar Jaiswal, Milena Pavlova

Research output: Contribution to journalArticleScientificpeer-review

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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 (beta=3.4213, p = 0.00), followed by familiarity with the doctor (beta=2.8497, p = 0.00) and attitude of the doctor and staff towards the patient (beta=1.8132, p = 0.00). As expected, respondents prefer shorter distance (beta=-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.

Original languageEnglish
Article number473
Number of pages11
JournalBMC Health Services Research
Volume18
DOIs
Publication statusPublished - 2018

Keywords

  • Health provider choice
  • Urban slums
  • Health-seeking behaviour
  • Discrete choice experiment
  • Bottom of the pyramid
  • SEEKING BEHAVIOR
  • TRADITIONAL MEDICINE
  • CARE-SEEKING
  • PREFERENCES
  • WOMEN
  • GUJARAT
  • SERVICES
  • DELIVERY
  • QUALITY
  • MATTER

Cite this

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title = "Underlying determinants of health provider choice in urban slums: Results from a discrete choice experiment in Ahmedabad, India",
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 (beta=3.4213, p = 0.00), followed by familiarity with the doctor (beta=2.8497, p = 0.00) and attitude of the doctor and staff towards the patient (beta=1.8132, p = 0.00). As expected, respondents prefer shorter distance (beta=-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.",
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author = "Vilius Cernauskas and F. Angeli and Jaiswal, {Anand Kumar} and Milena Pavlova",
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Underlying determinants of health provider choice in urban slums : Results from a discrete choice experiment in Ahmedabad, India. / Cernauskas, Vilius; Angeli, F.; Jaiswal, Anand Kumar; Pavlova, Milena.

In: BMC Health Services Research, Vol. 18, 473, 2018.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Underlying determinants of health provider choice in urban slums

T2 - Results from a discrete choice experiment in Ahmedabad, India

AU - Cernauskas, Vilius

AU - Angeli, F.

AU - Jaiswal, Anand Kumar

AU - Pavlova, Milena

PY - 2018

Y1 - 2018

N2 - 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 (beta=3.4213, p = 0.00), followed by familiarity with the doctor (beta=2.8497, p = 0.00) and attitude of the doctor and staff towards the patient (beta=1.8132, p = 0.00). As expected, respondents prefer shorter distance (beta=-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.

AB - 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 (beta=3.4213, p = 0.00), followed by familiarity with the doctor (beta=2.8497, p = 0.00) and attitude of the doctor and staff towards the patient (beta=1.8132, p = 0.00). As expected, respondents prefer shorter distance (beta=-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.

KW - Health provider choice

KW - Urban slums

KW - Health-seeking behaviour

KW - Discrete choice experiment

KW - Bottom of the pyramid

KW - SEEKING BEHAVIOR

KW - TRADITIONAL MEDICINE

KW - CARE-SEEKING

KW - PREFERENCES

KW - WOMEN

KW - GUJARAT

KW - SERVICES

KW - DELIVERY

KW - QUALITY

KW - MATTER

U2 - 10.1186/s12913-018-3264-x

DO - 10.1186/s12913-018-3264-x

M3 - Article

VL - 18

JO - BMC Health Services Research

JF - BMC Health Services Research

SN - 1472-6963

M1 - 473

ER -