Skip to main content
SpringerLink
Log in

Determinants of Demand for Outpatient Health Care in Rwanda

  • Chapter
  • First Online:
Studies on Economic Development and Growth in Selected African Countries

Part of the book series: Frontiers in African Business Research ((FABR))

Abstract

In the 2000s, the Government of Rwanda initiated health sector reforms aimed at increasing access to health care. Despite these reforms, there has not been a corresponding increase in demand for health services, as only about 30% of the sick use modern care (NISR in Preliminary results of interim demographic and health survey 2010. NISR, Kigali, 2011). The objective of this paper was to examine the factors influencing the demand for outpatient care in Rwanda and suggesting appropriate measures to improve utilization of health services. The data are from the Integrated Household Living Conditions Survey (EICV2) conducted in 2005 by the National Institute of Statistics Rwanda (NISR). A structural model of demand for health care is estimated to measure the demand effects of covariates. The findings indicate that health insurance is a significant determinant of outpatient medical care. In addition, the price of health care and household income are among the main drivers of utilization of health care. Women are more likely to seek outpatient health care as compared to men. Two main policy recommendations emerge from these findings. First, the government should reduce out-of-pocket healthcare expenditures (OOPE) through subsidies for public health facilities. Second, the government should reduce the premiums for community-based health insurance schemes (CBHIs) to increase coverage rates.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Ackerberg DA, Caves K (2003) Structural identification of production functions: an application to the timing of input choice. UCLA, Department of Economics, Los Angeles, CA

    Google Scholar 

  • Ahmad F (2001) Rural physicians perspectives on cervical and breast cancer screening: a Gender-based analysis. J Women’s Health Gender-Based Med 5(2):201–208

    Article  Google Scholar 

  • Ajakaiye O, Mwabu G (2007) The demand for reproductive health services: an application of control function approach. AERC, Nairobi

    Google Scholar 

  • Akin JS, Griffin DK, Popkin BM (1986) The demand for primary health services in the bicol region of the Philippines. Econ Dev Cult Change 34(4):755–782

    Article  Google Scholar 

  • Appleton S, Song L (1999) Income and human development at the household level, evidence from six countries. Oxford University, Mimeo

    Google Scholar 

  • Barros P, Machado P (2008) Moral hazard and the demand for health services: a matching estimator approach. J Health Econ 27(4):1006–1025

    Article  Google Scholar 

  • Bategeka LO, Asekeny L, Musiime JA (2009) The determinants of birth weight in Uganda. AERC, Nairobi

    Google Scholar 

  • Behrman JR, Deolalikar AB (1988) Health and nutrition. In: Chenery H, Srinivasan TN (eds) Handbook of development economics. Elsevier Science Publishers BV, North Holland

    Google Scholar 

  • Bhargava A, Jamison D, Lau L, Murray C (2001) Modeling the effects of health on economic growth. J Health Econ 20:423–440

    Article  Google Scholar 

  • Blomqvist AG, Carter RAL (1997) Is healthcare really a luxury? J Health Econ 16(2):207–229

    Article  Google Scholar 

  • Blunch N (2004) Maternal literacy and numeracy skills and child health in Ghana. Paper presented at the Northeast Universities Development Consortium Conference, HEC Montreal

    Google Scholar 

  • Buchmueller TC, Grumbach K, Kronick R, Kahn JG (2005) The effect of health insurance on medical care utilization and implications for insurance expansion: a review of the literature. Med Care Res Rev 62(1):3–10

    Article  Google Scholar 

  • Card D (2001) Estimating the return to schooling: progress on some persistent econometric problems. Econometrica 69(5):1127–1160

    Article  Google Scholar 

  • Cunningham P, Kemper P (1998) Ability to obtain medical care for the uninsured: How much does it vary across communities? JAMA 280(10):921–927

    Article  Google Scholar 

  • De Bethune X, Alfani S, Lahaye JP (1989) The influence of an abrupt price increase on health service utilization: evidence from Zaire. Health Policy Plan 4(1):76–81

    Article  Google Scholar 

  • Diop F, Yazbeck A, Bitrán R (1995) The impact of alternative cost recovery schemes on access and equity in Niger. Health Policy Plan 10:223–240

    Article  Google Scholar 

  • Elo I (1992) Utilization of maternal health-care services in Peru; the role of women’s education. Population Studies Center, University of Pennsylvania

    Google Scholar 

  • Florens JP, Heckman MC, Vytlacil E (2008) Identification of treatment effects using control functions in models with continuous, endogenous treatment and heterogeneous effects. Econometrica 76(5):1191–1206

    Article  Google Scholar 

  • Fredman L, Cauley JA, Satterfield S (2008) Caregiving, mortality, and mobility decline: the health, aging, and body composition (Health ABC) study. Arch Intern Med 168:2154–2162

    Article  Google Scholar 

  • Greene WL (2007) Econometric analysis. Macmillan Publishing Company, New York

    Google Scholar 

  • Griliches Z, Mairesse J (1998) Production functions: the search for identification. National Bureau of Economic Research, Working paper no. 5067

    Google Scholar 

  • Grossman M (1972) On the concept of health capital and the demand for health. J Polit Econ 80(2):223–235

    Article  Google Scholar 

  • Hahn B (1994) Healthcare utilization: the effect of extending insurance to adults on medicaid or uninsured. Med Care 32(3):227–239

    Article  Google Scholar 

  • Jayaraman AS, Chandrasekhar T, Gebreselassie T (2008) Factors affecting maternal healthcare seeking in Rwanda. USAID, Working paper

    Google Scholar 

  • Jones AM, Koolman X, Doorslaer EV (2006) The impact of having supplementary private health insurance on the use of specialists in European Countries. Anales d’Economie et de Statistique 83(84):251–275

    Google Scholar 

  • Jowett M, Deolalikar A, Martinsson P (2004) Health insurance and treatment seeking behaviour: evidence from a low-income country. Health Econ 13:845–857

    Article  Google Scholar 

  • Jütting JP (2003) Do community-based health insurance schemes improve poor people’s access to healthcare? Evidence from rural Senegal. World Dev 32:273–288

    Article  Google Scholar 

  • Katz L, Kling J, Liebman J (2001) Moving to opportunity in Boston: early results of a randomized mobility experiment. Q J Econ 116(2):607–654

    Article  Google Scholar 

  • Kioko MU (2008) The economic burden of malaria in Kenya: a household level investigation. PhD thesis, University of Nairobi

    Google Scholar 

  • Lawson D (2004) A microeconomic analysis of health, healthcare and chronic poverty, The University of Nottingham (unpublished)

    Google Scholar 

  • Lépine A, Nestour A (2008) Healthcare utilization in rural Senegal: the factors before the extension of health insurance to farmers. International Labor Office, Research paper no. 2

    Google Scholar 

  • Lindelow M (2002) Healthcare demand in rural Mozambique: evidence from 1996/97 household survey. International Food Policy Research Institute (IFPRI), FCND discussion paper no. 126

    Google Scholar 

  • Litvack JI, Bodart C (1993) User fees plus quality equals improved access to health care: results of a field experiment in Cameroon. Soc Sci Med 37:369–383

    Article  Google Scholar 

  • Manji JE, Moses SF, Bradley NJ, Nagelkerke MA, Plummer FA (1992) Impact of user fees on attendance at a referral centre for sexually transmitted diseases in Kenya. Lancet 340:463–466

    Article  Google Scholar 

  • Manning WG, Newhouse JP, Duan N, Keeler EB, Leibowitz A (1987) Health insurance and the demand for medical care: evidence from a randomized experiment. Am Econ Assoc Rev 77(3):251–277

    Google Scholar 

  • McCool JH, Kiker BF, Ng YC (1994) Estimates of the demand for medical care under different functional forms. J Appl Econometrics 9(2):201–218

    Google Scholar 

  • McKeown T (1976) The role of medicine: dream, mirage or nemesis? Basil Blackwell, Oxford

    Google Scholar 

  • Meer J, Harvey SR (2004) Insurance and the utilization of medical services. Soc Sci Med 58:1623–1632

    Article  Google Scholar 

  • Meza D (1983) Health insurance and the demand for healthcare. J Health Econ 2:47–54

    Article  Google Scholar 

  • Miller L (1994) Medical schools put women in curricula. Wall Street J B1

    Google Scholar 

  • Ministry of Health (MoH), Republic of Rwanda (2009) Health sector strategic plan (unpublished)

    Google Scholar 

  • Ministry of Health Rwanda (2009) Rwanda health financing policy review of Rwanda—options for universal coverage. World Health Organization

    Google Scholar 

  • Mocan NH, Tekin E, Jeffrey SZ (2004) The demand for medical care in urban China. World Dev 32(2):289–304

    Article  Google Scholar 

  • Mwabu KMJD, Nd’enge GK (2009) The consequences of fertility for child health in Kenya: endogeneity, heterogeneity and the control function approach. AERC, Nairobi

    Google Scholar 

  • Mwabu GJ, Wang’ombe B, Nganda B (2003) The demand for medical care in Kenya. African Development Bank, Oxford

    Google Scholar 

  • National Institute of Statistics of Rwanda (NISR) (2011) Preliminary results of interim demographic and health survey 2010. NISR, Kigali

    Google Scholar 

  • Nyman JA (2005) Health insurance theory: the case of the missing welfare gain, University of Minnesota (unpublished)

    Google Scholar 

  • Oxaal Z, Cook S (1998) Health and poverty gender analysis. Swedish International Development Co-operation (unpublished)

    Google Scholar 

  • Palmer T, Thompson J, Tobin M, Sheehan N, Burton P (2008) Adjusting for bias and unmeasured confounding in Mendelian randomization studies with binary responses. Int J Epidemiol 37(5):1161–1168

    Article  Google Scholar 

  • Phelps CE, Newhouse JP (1974) Coinsurance, the price of time, and the demand or medical service. Rev Econ Stat 56:334–342

    Article  Google Scholar 

  • Rashad IK, Markowitz S (2009) Incentives in obesity and health insurance. Inquiry 46:418–432

    Google Scholar 

  • Ridde V (2003) Fees-for-services, cost recovery, and equity in a district of Burkina Faso operating the Bamako Initiative. Bull World Health Organ 81:532–538

    Google Scholar 

  • Ringel JS, Hosek SD, Ben AV, Mahnovski S (2002) The elasticity of demand for healthcare. A review of the literature and its application to the military health system. National Defense Research Institute (unpublished)

    Google Scholar 

  • Rosenzweig MR, Schultz TP (1982) The behavior of mothers as inputs to child health: the determinants of birth weight, gestation, and the rate of fetal growth. In: Fuchs VR (ed) Economic aspects of health. The University of Chicago Press, Chicago, pp 53–92

    Google Scholar 

  • Saksena P, Xu K, Elovaino R, Perrot J (2010) Health services utilization and out-of-pocket expenditure at public and private facilities in low-income countries. World Health Organization, Background paper no. 20, Geneva

    Google Scholar 

  • Santerre RE, Neun SP (2010) Health economics: theories, insights and industry studies, 5th ed. Cengage Learning

    Google Scholar 

  • Sauerborn R, Nougtara A, Latimer E (1994) The elasticity of demand for healthcare in Burkina Faso: differences across age and income groups. Health Policy Plan 9(2):186–192

    Article  Google Scholar 

  • Schultz TP (2008) Population policies, fertility, women’s human capital. In Schultz TP, Strauss J (eds) Handbook of development economics, vol 4, Chap. 52. Elsevier, Amsterdam

    Google Scholar 

  • Shimeles A (2010) Community based health insurance schemes in Africa: the case of Rwanda. African Development Bank group, Working paper no. 120

    Google Scholar 

  • Staiger D, Stock JH (1997) Instrumental variables regression with weak instruments. Econometrica 65(3):557–586

    Article  Google Scholar 

  • Stock JH (2010) The other transformation in econometric practice: tools for inference. J Econ Perspect 24(2):83–94

    Article  Google Scholar 

  • Strauss J, Thomas D (1995) Human resources: empirical modeling of household and family decisions. In: Behrman J, Srinivasan TN (eds) Handbook of development economics, vol 3A. Elsevier Science, Amsterdam, pp 1883–2023

    Google Scholar 

  • Terza J, Basu A, Rathouz P (2008) Two-stage residual inclusion estimation: addressing endogeneity in health econometric modeling. J Health Econ 27(3):531–543

    Article  Google Scholar 

  • The World Bank (2001) World Bank Development Report 2000–2001: attacking poverty. Oxford University Press, Washington, DC

    Google Scholar 

  • Wooldridge JM (2002) Econometric analysis of cross-section and panel data. MIT Press, Cambridge, MA

    Google Scholar 

  • Yoder R (1989) Are people willing and able to pay for health services? Soc Sci Med 29(1):35–42

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Rwanda, Butare, Rwanda

    Charles Mulindabigwi Ruhara

  2. University of Nairobi, Nairobi, Kenya

    Urbanus Mutuku Kioko

Authors
  1. Charles Mulindabigwi Ruhara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Urbanus Mutuku Kioko
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Charles Mulindabigwi Ruhara .

Editor information

Editors and Affiliations

  1. Jönköping International Business School, Jönköping University, Jönköping, Sweden

    Almas Heshmati

Annexure 1

Annexure 1

See Tables 3.2 and 3.3.

Table 3.2 Marginal effects for the determinants of outpatient care
Full size table
Table 3.3 Determinants of demand for health insurance, first-stage regression (demand for outpatient care model)
Full size table

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer Nature Singapore Pte Ltd.

About this chapter

Cite this chapter

Ruhara, C.M., Kioko, U.M. (2017). Determinants of Demand for Outpatient Health Care in Rwanda. In: Heshmati, A. (eds) Studies on Economic Development and Growth in Selected African Countries. Frontiers in African Business Research. Springer, Singapore. https://doi.org/10.1007/978-981-10-4451-9_3

Download citation

Publish with us

Policies and ethics

Search

Navigation