An analysis of the determinants of access to medicines and health care in developing country settings

The research question of this thesis is what are the determinants of access to medicines and health care in developing countries? First, this thesis hypothesises that income is an important determinant of access to medicines and health care and that access is low for low income individuals. Second, this thesis hypothesises that an expectation of a high level of expenditure on medicines reduces the propensity to consume which implies a negative price elasticity. This thesis sets out to understand demand structures to answer this research question. The first chapter conducts an exploratory exercise to study government demand for medicines using price procurement data across a sample of developing countries. A different approach is used to impute price elasticities for medicines and range from -1.0 and -2.0. This means that a 1% increase in medicine prices, government demand for medicines will drop from 1% to 2%. The thesis begins the econometric analysis at the patient level using household survey data across a cross-section of 35 developing countries. Demand for health care is inelastic ranging from -0.19 to 0.6. The next two stages of empirical work use national household level data from India as a country case study. Price elasticities for outpatient care range from -0.17 to 0.43 and for inpatient care range from -0.13 to 0.03. Overall, the statistically significant price elasticity results are intuitive with a negative sign but are inelastic and at the lower end of the range found in the literature. The main determinants of health seeking behaviour are similar across different health settings studied in this thesis. These include having insurance and high household expenditure which implies that the poor will experience access problems. Other drivers include health status, gender, marital status, geographical location, education, employment and regulation. This thesis contributes to the evidence base because current research is limited and has typically drawn from smaller datasets. With a particular focus on medicines, the empirical findings offer policy implications in settings where pharmaceutical policies are not well developed. A broader approach to pharmaceutical policy making is necessary that considers reform measures on the demand and supply side from a health systems perspective