What determines health care utilization in Zambia?

Abstract

This study aims to ascertain factors that affect health care service utilisation in Zambia. The study is driven by the fact that despite Zambia recording impressive and improved health indicators for the period 2004 to 2012, the distributional use of health care services has been low against the expectation of high utilisation rate. Studies that have attempted to analyse factors that affect health care service use have used one-part models. This created a methodological deficiency in that unobserved factors, such as, agency relationship between patients and doctors are not captured by these one-part models. The Zero-Truncated-Poisson model is used in this study to capture the unobserved heterogeneities in determining health care service utilisation. The study used both average marginal effects and hurdle results to interpret the findings. It was found that age, distance, waiting time, insurance and health status have an effect on health care service utilisation. However, place of residence, sex, religion, marital status, education, household size, quality of health care, income and cost of health care services do not have a significant influence on health care service utilisation. A surprising finding was that distance and waiting time had a counter-intuitive positive effect on health care use as against an expected negative sign, but were statistically different from zero. This could have been as a result of the fact that most of the facility visits were at referral facilities