Economic Determinants of the Probability and Intensity of Health Care Utilisation: The Case of Egypt and Lebanon

Presenter: Heba Elgazzar, London School of Economics & Political Science

Abstract

The relationship between economic status and access to care is critical for informing health financing policy, but very little evidence exists in the Middle East and North Africa region. To formulate appropriate policies, information is needed on how economic status affects the use of the probability of care as compared to the amount of care received once access has been made. The objective of this paper is to compare the economic determinants of the probability and the intensity of care in two contrasting funding systems in the Middle Eastern countries, those of Egypt and Lebanon. The cases of physician services and hospital inpatient care are used to examine this question. Data were obtained from the 2001 World Health Organization Multi-Country Survey Study, a cross-sectional, multi-national household survey. The analysis employs multivariate binary and count regression methods.

Results suggest that the relationship between economic status and utilisation is generally stronger in the case of physician care than hospital care. This effect was more pronounced in the case of Lebanon as compared to Egypt. The effect was more pronounced regarding the probability of accessing care as compared to the intensity of services, as indicated by the number of visits to providers. These results suggest that demand-side factors such as income and health insurance coverage impact the decision to seek care by the individual. Overall, these factors were found to play less of a role in determining the amount of care, which may be more heavily influenced by supply-side factors in accordance with principal-agency theory. In health systems in which the state plays a larger role in enabling the use of preventative care, such as in Egypt, the effect of economic status appears lower than where the state plays a relatively minor role in financing health care, such as in Lebanon. This study highlights the role of the public sector in alleviating inequality in access to health services, particularly preventative care.