The Relative Effects of Health Program Inputs and Household Socioeconomic Status on Use of Services in a Context of Targeted Program Placement: The Case of Nicaragua

Gustavo Angeles, University of North Carolina at Chapel Hill
Margel Beteta, Instituto Nacional de Estadísticas y Censos - Nicaragua
Luis Blandon, Instituto Nacional de Estadísticas y Censos - Nicaragua

This study examines the relative effects of health program inputs and household socioeconomic status on individual use of basic health services in Nicaragua. It uses estimation methods to control for the potential bias created for the targeted placement of services across communities. The case of Nicaragua is interesting because of the significant changes in the use of health services that occurred between 1998 and 2001. This coincided with significant improvements in the supply of health services as a result of the reconstruction efforts after Hurricane Mitch. 1998 and 2001 DHS data linked to a 2001 health facility survey is used to specify a model of service utilization. Province-level data are used to specify an equation of health service program placement. The model is jointly estimated allowing for correlation among the unobservables influencing the use and program placement processes. Preliminary results indicate that there is a differential program effect in the "poor."