HEALTH CARE SYSTEM

Decision Making in Health Care System in Developing Country

Decision Making in Health Care System in Developing Country

Introduction

Understanding the factors that drive changes in the demand for health care in Developing countries is an important economic development and health policy concern (Barraza, 2006). More than half of the Mexican population lacks health insurance and is dependent on the publicly-sponsored health care system, and only about a third of the health care services demanded in the country are actually delivered through the private sector (IADB, 2001).

Access to health care has been identified as an important issue in developing public policies toward fighting poverty and improving population health (Lustig, 1998). For example, Developing countries' National Development Plan 2000-2009 contends that good health is a necessary condition to achieve equality in economic/social opportunities. The Plan states that there is a need to develop quality health care arrangements that are open to all Mexicans and that are accessible to everyone regardless of socioeconomic status (PR, 2001). Thus, gaining a better understanding on the decision-making process that determines the utilization of health services in Developing countries would be useful to assess the performance of policies related to health care system access.

Discussion

This study analyzes the decision-making process that determines the demand for health care in Developing countries. Although informed choice and shared decision-making between patients and physicians are common practices in many developed countries, these modes of patient-doctor interaction are less prevalent in developing countries (Macklin, 1999). In the case of Developing countries, the doctor-patient relationship can be characterized as paternalistic in the sense that the physician takes most of the responsibility for the medical decision-making and patients are less involved in, for example, the diagnosis, prognosis and proposed treatment (Macklin, 1999) and (Elwyn, 1999). As a result, patients initially decide to contact physicians based on their personal needs, but subsequent doctor-patient contact is most likely determined by the physician. Thus, viewing the demand for health care as a two-stage decision process in this setting is particularly appealing because it is likely that the patient decides first to obtain initial health care and the physician then determines the treatment intensity.

Two-part hurdle model of health care utilization

The demand for health care can be viewed as a derived demand in the sense that these services are required to maintain or improve a certain health status. As such, health care is essentially an input in the production of health (Pohlmeier, 1995). Individuals decide whether they should initially seek services from, for example, a physician, a specialist or to visit a hospital, by evaluating the marginal benefits and costs of improving their health. On the other hand, physicians primarily decide whether an individual should get additional medical attention (e.g., repeat visits/appointments).

This view of the demand for health care is particularly relevant in the case of Developing countries given that most of the medical decision-making after initial contact with the health care system is likely determined by the health care provider and, thus, patients are less likely to be involved in ...