Defining Access to Health Care: Evidence on the Importance of Quality and Distance in Rural Tanzania

We examine the implications of health seeking behavior on access to quality health care using a unique dataset that combines a household survey from rural Tanzania with the location and quality of all health facilities available to households. Patients do not always visit the nearest facility, but choose from among multiple facilities, improving the quality of care they receive by bypassing low quality facilities. Recognizing this behavior alters the projected benefits to health interventions, reducing the value of focusing on the staff qualifications and increasing the value of focusing on travel time and the motivation of current staff.