Abstract
Despite poverty and limited access to health care, evidence is growing that patients in low-income countries are taking a more active role in their selection of health care providers. Urban areas such as Nairobi, Kenya offer a rich context for studying these “active” patients because of the large number of heterogeneous providers available. We use a unique panel dataset from 2015 in which 402 pregnant women from peri-urban (the “slums” of) Nairobi, Kenya were interviewed three times over the course of their pregnancy and delivery, allowing us to follow women's care decisions and their perceptions of the quality of care they received. We define active antenatal care (ANC) patients as those women who switch ANC providers and explore the prevalence, characteristics and care-seeking behavior of these patients. We analyze whether active ANC patients appear to be seeking out higher quality facilities and whether they are more satisfied with their care. Women in our sample visit over 150 different public and private ANC facilities. Active patients are more educated and more likely to have high risk pregnancies, but have otherwise similar characteristics to non-active patients. We find that active patients are increasingly likely to pay for private care (despite public care being free) and to receive a higher quality of care over the course of their pregnancy. We find that active patients appear more satisfied with their care over the course of pregnancy, as they are increasingly likely to choose to deliver at the facility providing their ANC.
Highlights
Patients in the US and elsewhere are beginning to exercise more active choice in their selection of health providers (Leonard, 2013; Barbot, 2006; Hibbard and Greene, 2013)
We explore antenatal care-seeking in Nairobi, Kenya, where pregnant women have a wide array of maternity facility options within close proximity
Active patients turn increasingly to private care, even though antenatal care (ANC) in public facilities is free in Kenya, demonstrating an increasing willingness to pay for care over the course of pregnancy
Summary
Patients in the US and elsewhere are beginning to exercise more active choice in their selection of health providers (Leonard, 2013; Barbot, 2006; Hibbard and Greene, 2013). The most commonly used tool for measuring a patient's level of health engagement—the “Patient Activation Measure” (PAM)—captures items related to, for example, one's belief in one's own responsibility for health care and the importance of taking an active role in one's own health, as well as beliefs about the importance of communicating with doctors and understanding the role of procedures and medications (Hibbard et al, 2005) Higher scores on this measure have been shown empirically to be linked to higher utilization of preventive health care, fewer delays in treatment seeking, and the seeking out of health information, including comparisons of. Chan School of Public Health, 677 Huntington Ave, #1209 Building 1, Boston, MA 02115, USA
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