Anil Batta
Effective health care interventions are underutilized in the developing world, and income-related disparities in use are large. The evidence concerning this access problem is summarized and its demand side causes are identified. Broad strategies that have been proposed to tackle the access problem through changes in economic incentives are considered. It is argued that there is a need to go beyond the identification of broad strategies to the design and evaluation of specific policy measures. Only through experimentation and evaluation will we learn what works in raising health care utilization, particularly among the poor in the developing world. A large body of evidence confirms that many people in the developing world go without health care from which they could benefit greatly. The poor in developing countries are even less likely than the better off to receive effective health care. Concern for the level and distribution of health in the developing world demands that measures be taken to redress both facts. What are these measures? What policies can increase the utilization of effective health care, particularly by the poor in developing countries? There are two sides to the access problem. On the supply side, good quality, effective health care may not be offered. On the demand side, individuals may not utilize services from which they could benefit. The two are obviously related. Poor quality care will arouse little interest from the public. A high level of demand, made effective by purchasing power, will induce the provision of quality care. Solving the access problem requires tackling both demand and supply side issues. Given the space constraint, this paper will concentrate on the demand side, although a recurring theme will be that the response to demand side measures is dependent on supply side conditions. There is an urgent need to establish mechanisms that can increase the availability and improve the quality of health care in the developing world. For present purposes, let us suppose that effective health care interventions can be delivered. What are the barriers that constrain access to this care, particularly among the poor, and what policy measures offer the greatest potential to break down these barriers?