Srivastava, Divya
(2011)
An analysis of the determinants of access to medicines and health care in developing country settings.
PhD thesis, London School of Economics and Political Science.
Abstract
The research question of this thesis is what are the determinants of access to
medicines and health care in developing countries? First, this thesis hypothesises
that income is an important determinant of access to medicines and health care
and that access is low for low income individuals. Second, this thesis hypothesises
that an expectation of a high level of expenditure on medicines reduces the
propensity to consume which implies a negative price elasticity.
This thesis sets out to understand demand structures to answer this research
question. The first chapter conducts an exploratory exercise to study government
demand for medicines using price procurement data across a sample of
developing countries. A different approach is used to impute price elasticities for
medicines and range from -1.0 and -2.0. This means that a 1% increase in
medicine prices, government demand for medicines will drop from 1% to 2%.
The thesis begins the econometric analysis at the patient level using household
survey data across a cross-section of 35 developing countries. Demand for health
care is inelastic ranging from -0.19 to 0.6. The next two stages of empirical work
use national household level data from India as a country case study. Price
elasticities for outpatient care range from -0.17 to 0.43 and for inpatient care
range from -0.13 to 0.03. Overall, the statistically significant price elasticity
results are intuitive with a negative sign but are inelastic and at the lower end of
the range found in the literature. The main determinants of health seeking
behaviour are similar across different health settings studied in this thesis. These
include having insurance and high household expenditure which implies that the
poor will experience access problems. Other drivers include health status, gender,
marital status, geographical location, education, employment and regulation.
This thesis contributes to the evidence base because current research is limited
and has typically drawn from smaller datasets. With a particular focus on
medicines, the empirical findings offer policy implications in settings where
pharmaceutical policies are not well developed. A broader approach to
pharmaceutical policy making is necessary that considers reform measures on the
demand and supply side from a health systems perspective.
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