| Background: Recent efforts in International Health focus on increasing access to health services. These efforts contrast with a situation where resources for health are starting to grow at a slower rate, and more efficient use of existing resources is needed. One potential conflict is that providing health services to people in remote areas, necessary to achieve high levels of access, may cost more money than providing health services to people in other more centrally located areas. Additionally, populations living in different areas may have different demand for health services independent of their need for them.;Methods: Three case studies are used to explore relationships between place and the demand for and provision of health services. The first case study uses Seemingly Unrelated Regression to assess utilization of health centers in remote and rural areas of Afghanistan. The second uses a hybrid cost function to explore factors associated with the cost of providing health services in Malawi. The third used a multi-stage regression process to assess an association between different regions in Burkina Faso and reported illness, care seeking, and payment for health services.;Results: The first study found that health centers located in remote areas may incur over 50% greater salary costs than comparable facilities located in rural areas. The second study found an association between health centers located in areas with lower catchment population and lower utilization rates and efficiency. The third case study found that there was not association between regions and reported illness, but that regional differences persist for care seeking, as well as if and how much payments were made for care.;Conclusion: Health systems have multiple goals, implying that there are likely trade-offs between the multiple objectives. By quantifying these tradeoffs, policy makers can better understand the implications of the decisions they make. This dissertation has put numbers on tradeoffs related to efficiency and horizontal equity. It has not fully answered these questions, but the consistency in the findings in the demand for and provision of health care services is suggestive that further research in this area could be fruitful. |
