Health care utilisation in a developing country -the case of Zambia

Abstract: The aim of this thesis is to contribute to our understanding of health care utilisation and its determinants in developing countries, especially in sub-Saharan Africa. This is done by explicitly focusing on health care expenditures and its determinants as well as the choice to seek health care to cure the illness. Firstly, the focus is on a household’s expenditures for health care. The aim of this paper is to explore the determinants of health care utilisation of Zambian households and in particular whether other factors than just health status influence utilisation in developing countries. The results point out a significant difference between households in rural and urban areas as well as between poor and non-poor households regarding the magnitude of health care expenditures. In general, results show that the households are influenced by economic status, illness and access variables such as distance and owning a vehicle. Secondly, a sick individual’s choice of health care and expenditures related to it are analysed. In this paper the aim is on the one hand to determine what factors influence sick individuals’ propensity to seek health care at a health facility or to use self-medication (or do nothing), and on the other hand to determine the factors that influence the magnitude of the expenditures they incur for health care. We find that the individuals’ utilisation is influenced by economic status, education, insurance, type of illness and access variables such as distance and owning a vehicle.Thirdly, only children are focused on in analysing the determinants of those being taken to professional health care when sick, and then, given that health care is provided, estimating determinants of the level of expenditures incurred. The results show that children’s utilisation of professional health care is influenced by the household’s economic status, mother’s education, age, household ownership of motor transportation, child being an orphan (mother dead), distance to health care and living in a rural area. Then, in the last paper, Zambian households’ access to health care facilities are analysed. The results of the analysis indicate that there are inequalities among socio-economic groups, especially between rural and urban areas. In particular these differences exist because of differing distances to the nearest health facility.With these papers on Zambia and their different angles, a comprehensive picture of health care utilisation and factors influencing it in a sub-Saharan context is given. Interestingly, we can conclude that health care utilisation among individuals in developing countries is greatly influenced by the same factors as have been shown to influence individuals in developed countries.