People make choices for health care even in poor countries with limited access to health services. Many factors drive patient choice – patients seek services they believe to be more convenient, affordable, and of higher quality. In this week’s class reading Margaret Kruk and colleagues discuss the choices made by women in an impoverished area in rural Tanzania. Kruk found that 40% of women bypassed their village level primary care facilities for obstetric care at a larger hospital. The women who bypassed the nearest facility commonly cited a perception of poor quality in the village center.
Just like the women in rural Tanzania, the urbanized population of NYC behaves in similar fashion making choices for their health. Working as an emergency department physician assistant in NYC in different locations, I have treated patients from different socio-economic strata. The rich and poor often travel outside their neighborhoods bypassing their community hospitals to seek “better care.” For some, “better” means avoiding long waiting times and for others, it means that the patient believes they will receive higher quality care.
Travel for health care is not a one-way street to high-tech services. Westerners may travel across the globe shopping for a kidney, or some may travel to obtain an expensive surgical intervention for a lower out-of-pocket expense.
The demand side of the health care equation plays an important role in how we organize and deliver health care services, in the developing and the Western worlds. In some areas, demand may play out as patients requesting an MRI for chronic back pain, whereas in another locale, it may drive utilization of a village clinic.