Demand for curative health care in rural Ecuador

The analysis uses the results of a household survey of 1,017 rural households and a survey of nine SSC clinics to determine the potential effect of policy options, such as improving the quality of health care, increasing the rate of referrals to higher level facilities, and increasing user fees, on SSC"s three major goals: (1) to increase utilization of SSC health facilities; (2) to expand membership; and (3) to promote the financial sustainability of the SSC. The overall conclusion of the study is that investing in improved quality of care, particularly by increasing the drug supply and the number of physician hours of service, and perhaps by increasing referrals, would increase SSC membership and overall utilization. Furthermore, the low sensitivity of demand for services to modest changes in patients" out-of-pocket expenses suggests that it may be possible to finance these quality improvements through a combination of increased dues and user fees. (Author abstract, modified)