Factors Affecting Health Care Demand

Income. Higher-income families tend to have higher actual use of health services because they are able to afford the cost But since
they can also afford preventive care, they are able to reduce their real need for health services. This is the so-called double effect of
income.

Price. Price has a negative effect on the demand for health care. Although total demand for health care was found in several studies
to be not so responsive to price changes, selection of the source of health care services was observed to be influenced by the price
factor. For example, Heller discovered that the decision to use or not to use public facilities was affected by the price of private
health care.

Health Insurance. Aside from reducing the net price of health care, insurance may be viewed as a method of financing the demand
for health care.

Age. The incidence of illness varies with age, so does the need for health care. The presence of children and elderly persons in the
family raises the frequency of illness, which in turn increases the` use of health services.

Sex. To isolate the effect of sex on demand, factors such as age and health status are considered in a model specification. However,
attempts to do so yielded weak results; only marginal differences in usage were detected.

Family Size. The effect of family size on the use of health services is unpredictable. A large family has a higher frequency of
illness since it has more potential patients. However, it has less income per capita than a small family belonging to the same income
level.

Education. Greater amount of education may enable a person to recognize early symptoms of illness, resulting in the patient’s
greater willingness to seek early treatment. The patient spends more for preventive services and less for curative services.

Health Knowledge and Beliefs. An individual’s health knowledge and beliefs affect his efficiency in maintaining personal health
through dietary, hygienic, and preventive measures. It also affects the choice of health facilities.

Health Need. Demand for health care is based upon felt needs. Doctors assess whether felt needs are actual needs. Some turn out to
be so. Self-perceived need determines whether or not an individual is in the market for health care. It is the immediate cause of
decision to seek medical care.

Distance of Source of Health Care. Distance has been the most studied hindrance to the use of health facility. The more distant a
facility is from potential users, the less likely it is to be visited.

HEALTH INDICATORS

- are quantifiable characteristics of a population which researchers use as supporting evidence for describing the health of a
population. Typically, researchers will use a survey methodology to gather information about certain people, use statics in an
attempt to generalize the information collected to the entire population, the use the statistical analysis to make a statement about the
health of the population.
According to Morgenstern, measuring helth variables involves in using different levels of the measurements which can be generated
in two ways.
1. By direct individual observation
2. By observation of population groups or location-based obsrvation. Rates and proportions are generated; averages, and medians.

Indicators of Health:
• Health status indicators measure different aspects of the health of a population.
• Health determinant indicators measure things that influence health.

CHARACTERISTICS of Health Indicator

a) Valid – they should actually measure what they are supposed to measure.
b) Reliable – the results should be the same when measured by different people in similar circumstances.
c) Sensitive – they should be sensitive to changes in the situation concerned.
d) Specific – they should reflect changes only in the situation concerned.
e) Feasible – they should have the ability to obtain data when needed.
f) Relevant – they should contribute to the understanding of the phenomenon of interest.

USES OF INDICATORS OF HEALTH

a. Measurement of the health of the community.
b. Description of the health of the community.
c. Identification of health needs and prioritizing them.
d. Evaluation of health services
e. Planning and allocation of health resources
 f. Measurement of health successes.s

INDICATORS can be…

1. Count / Number- Measure without a denominator.
2. Proportion (%) - Numerator is part of denominator.
3. Rate - Frequency of occurrence of an event during a specific time, usually expressed per “k” population (k=1000….)(constant na
siya).
4. Ratio - Measure for which numerator is not included in denominator (e. g : sex ratio per 100 ; beds population per 1000) .
5. Index - Aggregation of measurement of specific indicators. (e. g : Health development index).

Who compiles health indicator?

 Reports are compiled at every jurisdictional level
 State and local level - Health departments, foundations and philanthropic organizations, businesses, educational, law
enforcement, human services providers, and other civic leaders, faith organizations, universities, media.
 National – Federal government/private partnerships.
 International – WHO

Health indicators are required in order to measure the health status of people and communities.

CLASSIFICATION OF INDICATORS
1) Mortality Indicators :
a) Crude death rate
b) Life expectancy
c) Infant mortality rate
d) Maternal mortality rate
e) Proportional mortality rate

Mortality Rate or Death Rate

- measure of the number of the death s (in general, or due to a specific cause) in a particular population, scaled to
the size of that population, per unit of time.
- Mortality rate is typically expressed in units of deaths per 1,000 individuals per year.

Other specific measures of mortality include.

I. Crude death rate
-the total number of deaths per year per 1,000 people.
- The crude death rate depends on the age(and gender) specific mortality rates and the age (and gender)
distribution of the population.
- This is considered a fair indicator of comparative health of the people.

= which indicates that there were about 18 deaths per 1000

inhabitants in the year 1999.

II. Prenatal mortality rate

- The sum of neonatal deaths and fatal deaths(stillbirth) per 1000 births.
III. Maternal mortality ratio-
- The number of maternal deaths per 100,000 live births in same time period.
 IV, Maternal mortality rate
- The number of maternal deaths per 1,000 women of reproductive age in the population (generally defined
as 15-44 years of age)
V. Infant mortality rte
- The number of deaths of children less than 1 year old per 1,000 live births
VI. Child mortality rate
- The number of deaths of children less than 5 year old per 1,000 live births.
VII. Standardised Mortality rate (SMR)
- a proportional comparison to the numbers of deaths that would have been expected if the population had been
of a standard composition in terms of age, gender, etc.
VIII. Age-specific mortality rate (ASMR)
- The total number of deaths per year per 1,000 people of a given age ( e.g. age 62 last birthday)
IX. Cause-specific mortality rate
- The mortality rate for a specified cause of death.

The cause specific death rate per 100,000 for tuberculosis in South Africa in 1993 was:

X. Case fatality rate

- The proportional of cases of a particular medical condition that lead to death within a specified period of time.

Other measures of mortality used to provide indications of the relative success or failure of medical treatment on
procedures (for life-threatening illness etc.) include:
 Early mortality rate- the total number of deaths in the early stages of an ongoing treatment, or in the period immediately
following an acute treatment
 Late mortality rate- the total number of deaths in the late stages of an ongoing treatment, or a significant length of time
after an acute treatment

2) Morbidity Indicators
- The frequency with which a disease appears in a population. reveal the burden of ill health in a community, but do not
measure the subclinical or in apparent disease states.

The major methods for gathering morbidity data are through surveillance systems and sample surveys.
Disease Surveillance
ŠInitially concerned with infectious diseases
ŠCurrently includes a wider range of health data including
– chronic diseases
– environmental risk factors
– health care practices
– health behaviors

A. Incidence Rate
-is a measure of the probability of occurrence of a given medical condition in a population within a specified period of
time.
- E.g. Incidence of TB (new sputum cases) is 168 per 100000 population per year
B. Prevalence Rate
- The total number of all individuals who have an attribute or disease at a particular time divided by population at risk of
having attribute or disease at this point of time
- Reflects the chronicity of the disease
- E.g. Prevalence of TB (sputum in population) is 249 per 100000 population 14

Health status (conditions)

Incidence counts of any of the following in a population may be health indicators:
 Low birth weight
 Obesity
 Arthritis
 Diabetes
 Asthma
 High blood pressure
 Cancer incidence
 Depression
 Chronic pain
 Hospital vitals due to injury
  Reports of waterborne disease or food-borne illness

3) Disability Rates
-Based on premises or portion that health implies a full range of daily activities.
Disability is defined as “any restriction or lack of ability to perform an activity in a manner or within the range
considered normal for a human being.”
According to the World Health Organization, disability has three dimensions:1

1. Impairment in a person’s body structure or function, or mental functioning; examples of impairments include loss of a
limb, loss of vision or memory loss.
2. Activity limitation
3. Participation restrictions in normal daily activities

Types:
a. Event type indicators
-number of days of restricted activity
- Bed disability days
- Work-loss days within a specified period
b. Person type indicators -
- Limitation of mobility e.g. confined to bed, confined to house, special aid in getting around.
- Limitation of activity e.g. limitation to perform the basic activities of daily living (ADL) e.g. eating, washing,
dressing, etc. 16

4) Nutritional Status Indicators

Nutritional Status is a positive health indicator.

Newborns are measured for their

i. Birth–weight
ii. Length etc.
They reflect the maternal nutrition status.

Anthropometric measurements of pre-school children.

i. Weight – measures acute malnutrition.
ii. Height – measures chronic malnutrition.

 Growth Monitoring of children is done by measuring weight- for-age, height-for-age, weight-for- height, head & chest
circumference and mid-arm circumference.
 In adults Underweight, Obesity and Anemia are generally considered reliable nutritional indicators.

 Underweight (acute or chronic malnutrition, or both): low weight for age

 Stunting (chronic malnutrition): low height for age
 Wasting (acute malnutrition)): low weight for height
 Overweight: high weight for height

5) Health Care Delivery Indicators

These indicators reflect the equity of distribution of health resources in different parts of the country and of the provision of
health care.

Frequently used indicators:

◦ Doctor-population ratio
◦ Doctor-nurse ratio
◦ Population-bed ratio
◦ Population per health/sub centre
◦ Population per traditional birth attendant

The WHO Joint Learning Initiative has established a threshold of 25 health workers (doctors, nurses and midwives) per 10,000
populations, with a WHO endorsed lower threshold of 23 workers per 10,000.

6) Utilization Rates
-Expressed as proportion of people in need of health care services who actually receive it in a given period.

 Proportion of infants who are fully immunized against the Seven EPI diseases.
 Percentage of population using the various methods of family planning.
 Proportion of pregnant women who receive ANC care or have institutional deliveries supervised by a trained birth attendant
 Bed-occupancy rate ( eg. Average daily in-patient census/average number of beds)
 Average length of stay (eg. Days of care rendered/discharges)
 7) Indicators of Social And Mental Health
- These indicators provide a guide to social action for improving the health of people.
- Social and mental health of the children depend on their parents.

These Include rates of:

 Suicide, homicide, other crime
 road traffic accidentt
 juvenile delinquency
 alcohol and substance abusee
 domestic violence
 Battered-baby syndrome, etc.

8) Environmental Indicators
- These reflect the quality of physical and biological environment in which diseases occur and people live.
- The most important are those measuring the proportion of population having access to safe drinking water and sanitation
facilities.
- These indicators explains the prevalence of communicable diseases in a community
- The other indicators are those measuring the pollution of air and water, radiation, noise pollution, exposure to toxic
substances in food and water

9) Socio-economic Indicators
- These Indicators do not directly measure health.
- They are of importance in interpretation of indicators of health care.

These include:
a) Rate of population increase
b) )Per capita GNI(Gross national income)
c) Level of unemployment
d) Dependency ratio
e) Literacy rate, especially female literacy rate
f) Family size
g) Housing, the number of persons per room
h) Per capita calorie availability

10) Health Policy Indicators

- The single most important indicator of political commitment is "allocation of adequate resources".
- The relevant indicators are:
(i) Proportion of GNP spent on health services
(ii) Proportion of GNP spent on health-related activities (including water supply and sanitation, housing and nutrition,
community development)
(iii) Proportion of total health resources devoted to primary health care.

11) Indicators of Quality of Life

- Life expectancy is no longer important. The Quality Of Life has gained its importance. Quality of life is difficult to define
and even more difficult to measure.

Various attempts have been made to reach one composite index from a number of health indicators.

________________________________________
Characteristics of Health Care
• Appropriateness (relevance)
• Comprehensiveness
• Adequacy
• Availability
• Accessibility
• Affordability
• Feasibility