Examining the Effect of Supply and Demand-Side Interventions to Increase Health Service Use

Abstract

In both the United States and low-income countries, health service quality and utilization fall below global and national targets set by policy makers. This dissertation examines three different approaches to increasing the coverage and quality of health services. In the first paper of this thesis, “The effect of the Affordable Care Act on patient out-of-pocket cost and use of preventive cancer screenings in Massachusetts”, we find that, following the ACA, patients in Massachusetts receiving a preventive cancer screening were less likely to pay any out-of-pocket costs, but there was no significant effect on cancer screening utilization. This work suggests that eliminating cost sharing may not always be an effective policy tool to increase health service use. In some cases, policy makers may need to consider other complementary policy options to increase screening rates. In the second paper, “Waiting Time, Wasted Time: A study to investigate the effect of reduced waiting time on demand for antenatal care”, we found that scheduling appointments reduced waiting time for antenatal care in treatment facilities. We also find that appointment scheduling increased the likelihood that women attend four or more antenatal care visits during pregnancy. As long waiting time is perceived to be a problem for other health services, and in other counties in Sub-Saharan Africa, the results of this pilot suggest that appointment scheduling could decrease waiting time in other settings. Further, our results suggest that improvements in quality that affect the user experience of health care may help increase receipt of recommended health care during pregnancy. The third paper, “Female voices, community choices: a randomized controlled trial to evaluate the impact of gender composition on community meeting outcomes,” focuses on whether the gender of community meeting participants affects Community Monitoring programs. We find that mixed-gender and women’s community meetings resulted in similar health service improvement priorities. However, quality-related issues were more common in women's meetings. Our findings suggest that in North West Cameroon, men and women largely have the same health service improvement priorities, and there is no need for policy makers to alter the standard program model of mixed-gender meetings.