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Transaction costs of access to health care: Implications of the care-seeking pathways of tuberculosis patients for health system governance in Nigeria.

Abimbola S, Ukwaja KN, Onyedum CC, Negin J, Jan S, Martiniuk AL - Glob Public Health (2015)

Bottom Line: The patients provided information on their care-seeking pathways and the associated costs prior to reaching the appropriate provider.Notably, 62% of total transaction costs were incurred during the first visit to an inappropriate provider and the mean transaction costs incurred was highest with QPs (US$30.20) compared with PPs (US$14.40) and TPs (US$15.70).These suggest that interventions for reducing transaction costs should include effective decentralisation to integrate TB care with services at the primary health care level, community engagement to address information asymmetry, enforcing regulations to keep informal providers within legal limits and facilitating referral linkages among formal and informal providers to increase early contact with appropriate providers.

View Article: PubMed Central - PubMed

Affiliation: a School of Public Health , University of Sydney , Sydney , NSW , Australia.

ABSTRACT
Health care costs incurred prior to the appropriate patient-provider transaction (i.e., transaction costs of access to health care) are potential barriers to accessing health care in low- and middle-income countries. This paper explores these transaction costs and their implications for health system governance through a cross-sectional survey of adult patients who received their first diagnosis of pulmonary tuberculosis (TB) at the three designated secondary health centres for TB care in Ebonyi State, Nigeria. The patients provided information on their care-seeking pathways and the associated costs prior to reaching the appropriate provider. Of the 452 patients, 84% first consulted an inappropriate provider. Only 33% of inappropriate consultations were with qualified providers (QP); the rest were with informal providers such as pharmacy providers (PPs; 57%) and traditional providers (TP; 10%). Notably, 62% of total transaction costs were incurred during the first visit to an inappropriate provider and the mean transaction costs incurred was highest with QPs (US$30.20) compared with PPs (US$14.40) and TPs (US$15.70). These suggest that interventions for reducing transaction costs should include effective decentralisation to integrate TB care with services at the primary health care level, community engagement to address information asymmetry, enforcing regulations to keep informal providers within legal limits and facilitating referral linkages among formal and informal providers to increase early contact with appropriate providers.

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Related in: MedlinePlus

The pathways patients followed to reach tuberculosis service in Ebonyi State, Nigeria, 2011. Source: Adapted from the format in Kapoor et al. (2012).
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f0001: The pathways patients followed to reach tuberculosis service in Ebonyi State, Nigeria, 2011. Source: Adapted from the format in Kapoor et al. (2012).

Mentions: Approximately 16% of the patients (72 of the 452) reported consulting an NTP provider first, whereas 84% consulted a non-NTP provider first, 36 (8%) a TP, 284 (63%) a PP and 60 (13%) a QP (Figure 1). Transaction costs per patient (including costs incurred at subsequent pre-NTP visits) were highest for those whose first pre-NTP visit was to a QP (US$79.80 over an average of 2.2 visits), compared with those who first contacted a PP (US$22.10 over an average of 1.4 visits) or a TP (US$20.20 over an average of 1.7 visits; Table 1). Likewise, the average transaction cost incurred per pre-NTP visit was highest for QPs (US$30.20), double that of PPs (US$14.40) and TPs (US$15.70). In all, approximately 52% of patients sought medical care from one provider before an NTP provider, 17% sought care from two providers, 13% from three and 1% from four providers before an NTP provider (Table 1). The amount of transaction costs incurred increased with the number of providers visited before an NTP provider, such that those who saw one incurred an average of US$16, two incurred US$26.70, three incurred US$85.40 and four incurred US$134 per patient (P < 0.001).


Transaction costs of access to health care: Implications of the care-seeking pathways of tuberculosis patients for health system governance in Nigeria.

Abimbola S, Ukwaja KN, Onyedum CC, Negin J, Jan S, Martiniuk AL - Glob Public Health (2015)

The pathways patients followed to reach tuberculosis service in Ebonyi State, Nigeria, 2011. Source: Adapted from the format in Kapoor et al. (2012).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4696418&req=5

f0001: The pathways patients followed to reach tuberculosis service in Ebonyi State, Nigeria, 2011. Source: Adapted from the format in Kapoor et al. (2012).
Mentions: Approximately 16% of the patients (72 of the 452) reported consulting an NTP provider first, whereas 84% consulted a non-NTP provider first, 36 (8%) a TP, 284 (63%) a PP and 60 (13%) a QP (Figure 1). Transaction costs per patient (including costs incurred at subsequent pre-NTP visits) were highest for those whose first pre-NTP visit was to a QP (US$79.80 over an average of 2.2 visits), compared with those who first contacted a PP (US$22.10 over an average of 1.4 visits) or a TP (US$20.20 over an average of 1.7 visits; Table 1). Likewise, the average transaction cost incurred per pre-NTP visit was highest for QPs (US$30.20), double that of PPs (US$14.40) and TPs (US$15.70). In all, approximately 52% of patients sought medical care from one provider before an NTP provider, 17% sought care from two providers, 13% from three and 1% from four providers before an NTP provider (Table 1). The amount of transaction costs incurred increased with the number of providers visited before an NTP provider, such that those who saw one incurred an average of US$16, two incurred US$26.70, three incurred US$85.40 and four incurred US$134 per patient (P < 0.001).

Bottom Line: The patients provided information on their care-seeking pathways and the associated costs prior to reaching the appropriate provider.Notably, 62% of total transaction costs were incurred during the first visit to an inappropriate provider and the mean transaction costs incurred was highest with QPs (US$30.20) compared with PPs (US$14.40) and TPs (US$15.70).These suggest that interventions for reducing transaction costs should include effective decentralisation to integrate TB care with services at the primary health care level, community engagement to address information asymmetry, enforcing regulations to keep informal providers within legal limits and facilitating referral linkages among formal and informal providers to increase early contact with appropriate providers.

View Article: PubMed Central - PubMed

Affiliation: a School of Public Health , University of Sydney , Sydney , NSW , Australia.

ABSTRACT
Health care costs incurred prior to the appropriate patient-provider transaction (i.e., transaction costs of access to health care) are potential barriers to accessing health care in low- and middle-income countries. This paper explores these transaction costs and their implications for health system governance through a cross-sectional survey of adult patients who received their first diagnosis of pulmonary tuberculosis (TB) at the three designated secondary health centres for TB care in Ebonyi State, Nigeria. The patients provided information on their care-seeking pathways and the associated costs prior to reaching the appropriate provider. Of the 452 patients, 84% first consulted an inappropriate provider. Only 33% of inappropriate consultations were with qualified providers (QP); the rest were with informal providers such as pharmacy providers (PPs; 57%) and traditional providers (TP; 10%). Notably, 62% of total transaction costs were incurred during the first visit to an inappropriate provider and the mean transaction costs incurred was highest with QPs (US$30.20) compared with PPs (US$14.40) and TPs (US$15.70). These suggest that interventions for reducing transaction costs should include effective decentralisation to integrate TB care with services at the primary health care level, community engagement to address information asymmetry, enforcing regulations to keep informal providers within legal limits and facilitating referral linkages among formal and informal providers to increase early contact with appropriate providers.

Show MeSH
Related in: MedlinePlus