The Spatial Distribution of Health Care Services Within Countries


Aim 1: Document differences in health outcomes and access to health care across regions within countries. For this purpose, we aim to construct a database with the location and staffing of the universe of health facilities for a large number of countries, at all stages of development. Aim 2: Establish the causal link between access to health care and health outcomes. To this end, we aim to: (i) Differentiate between location- and population-specific drivers of differences in health outcomes, (ii) Assess the extent to which location effects can be explained by differences in access to health care (density of facilities, quality of facilities, staffing, etc.) As a starting point, we plan to study child mortality and birth outcomes more generally, and potentially expand towards other relevant health outcomes. Aim 3: Use answers to the points above to investigate the extent to which countries could improve aggregate health outcomes by allocating health care resources differently across space. Aim 4 : In the long run, we also aim to develop an international network of researchers around the aforementioned dataset, following the experience of other successful models of comprehensive micro-level datasets like the World Inequality Dataset.


It has been widely documented that low- and middle-income countries are characterized by scarcity of health care resources. Lack of resources at the national level, however, may mask substantial differences in access to health care within countries. In this project we aim to provide answers to three fundamental questions in health care. First, how unequally is access to health care distributed within countries? Second, to what extent can withincountry differences in health care resources explain within-country differences in health outcomes? Third, to what extent could countries distribute their resources more efficiently as to achieve better aggregate health outcomes? This project aims to address these questions by a) conducting a comparative cross-country study of the spatial distribution of health care facilities and health care workers within countries, b) studying the causal effect of access to health care on health outcomes. These two inputs are the necessary information to evaluate the efficiency of different allocations of resources. The project consists of a data collection phase, followed by an econometric analysis to establish the linkages between access to health care and health outcomes. The econometric analysis consists of two parts. First, we aim to estimate the extent to which regional differences in health outcomes are due to location-specific characteristics rather than characteristics of the populations in the different locations. Second, we plan to establish the extent to which these “location effects” can be explained by differences in the supply of health care resources across locations (as opposed to differences in other location-specific environmental determinants of health).

Funded By: 
Award Dates: 
July 1, 2019 - June 30, 2020