A paper published this summer by University researchers concluded that, in Mali, price is a more significant barrier to healthcare than a lack of information. Researchers offered both subsidies and informational health worker visits to a population of 1,544 Malian children and found that the former resulted in a much broader use of healthcare resources while the latter had minimal effects.
Even with subsidies that drastically reduced costs, 70 percent of cases that warranted care in the sample of Malian children were not brought into a doctor — a sign that there is still much work to be done on making healthcare accessible in the region.
The research was unusual in that it implemented a model of care-seeking that focused on time dynamics in order to determine whether existing resources are being underused or overused, said Kelsey Jack, assistant professor of economics at Tufts University. “Seeking treatment at the right time is really important, both from a policy standpoint and a household welfare standpoint.”
Going to the doctor too soon constitutes overuse because the visit may be unnecessary. “Children often have a cold or a little bit of fever or diarrhea,” wrote Anja Sautmann, lead author of the study and assistant professor of economics, in an email to The Herald. “It’s making them and probably the parent very cranky, but it is a harmless infection that will pass on its own.” On the other hand, waiting too long to see a doctor while symptoms continue or worsen could deprive the child of necessary treatment. That would be considered underuse of healthcare, she added.
In offering the study’s population subsidized care while assessing time dynamics, the researchers sought to establish whether increased financial resources for care would lead to overuse. Policy makers are often worried that subsidies lead people to waste resources and that people are not sufficiently well informed to know when they should visit the doctor, Sautmann wrote.
“We don’t know what happens when you extend these kinds of subsidies to large populations,” said Jishnu Das, a lead economist at the World Bank, adding that subsidizing an entire city might have very different effects. “There is a big difference between experiment and policy.”
Two things influence when people go to the doctor, said Mark Dean, assistant professor of economics at Columbia: how much a doctor’s visit costs and how well people can diagnose themselves. Some see the provision of financial and informational resources as a delicate balance because cheap healthcare could result in uninformed overuse, but disseminating information does not make doctor’s visits affordable.
But the study’s results showed that concerns about overuse given additional resources do not “hold true,” Sautmann wrote.
Without intervention by the researchers, overuse of healthcare was found to be very uncommon. “The children in our sample see a doctor in only about 3 percent of illness spells where the symptoms do not indicate a need for care,” Sautmann wrote. But “underuse is rampant,” Sautmann added. Of the cases that warranted seeing a doctor, only 11 percent sought care.
With subsidies, there was much greater demand for healthcare — an increase of almost 300 percent. “This increase is much stronger on days when care is required than when it is still too early,” Sautmann wrote, adding that this data suggests parents already know when medical attention is required. Informational visits from healthcare workers did little to lessen overuse and did not remedy underuse.
“These people have a pretty good idea about when they should be taking kids to the doctor. It’s just that it’s too expensive to do so,” Dean said. “The barrier to efficient use of healthcare is monetary, not informational.”
