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Transaction costs of access to health care: Implications of the care-seeking pathways of tuberculosis patients for health system governance in Nigeria.
- Source :
- Global Public Health; Oct2015, Vol. 10 Issue 9, p1060-1077, 18p
- Publication Year :
- 2015
-
Abstract
- Health care costs incurred prior to the appropriate patient–provider transaction (i.e., transaction costs of access to health care) are potential barriers to accessing health care in low- and middle-income countries. This paper explores these transaction costs and their implications for health system governance through a cross-sectional survey of adult patients who received their first diagnosis of pulmonary tuberculosis (TB) at the three designated secondary health centres for TB care in Ebonyi State, Nigeria. The patients provided information on their care-seeking pathways and the associated costs prior to reaching the appropriate provider. Of the 452 patients, 84% first consulted an inappropriate provider. Only 33% of inappropriate consultations were with qualified providers (QP); the rest were with informal providers such as pharmacy providers (PPs; 57%) and traditional providers (TP; 10%). Notably, 62% of total transaction costs were incurred during the first visit to an inappropriate provider and the mean transaction costs incurred was highest with QPs (US$30.20) compared with PPs (US$14.40) and TPs (US$15.70). These suggest that interventions for reducing transaction costs should include effective decentralisation to integrate TB care with services at the primary health care level, community engagement to address information asymmetry, enforcing regulations to keep informal providers within legal limits and facilitating referral linkages among formal and informal providers to increase early contact with appropriate providers. [ABSTRACT FROM PUBLISHER]
- Subjects :
- EVALUATION of medical care
TUBERCULOSIS diagnosis
TUBERCULOSIS treatment
MEDICAL care
ACADEMIC medical centers
CONFIDENCE intervals
STATISTICAL correlation
DECENTRALIZATION in management
HEALTH services accessibility
INTERVIEWING
MEDICAL care costs
MEDICAL referrals
PRIMARY health care
PROBABILITY theory
QUESTIONNAIRES
RESEARCH funding
SURVEYS
LOGISTIC regression analysis
MULTIPLE regression analysis
CROSS-sectional method
DATA analysis software
DESCRIPTIVE statistics
SECONDARY care (Medicine)
ODDS ratio
Subjects
Details
- Language :
- English
- ISSN :
- 17441692
- Volume :
- 10
- Issue :
- 9
- Database :
- Complementary Index
- Journal :
- Global Public Health
- Publication Type :
- Academic Journal
- Accession number :
- 109462663
- Full Text :
- https://doi.org/10.1080/17441692.2015.1007470