# _Health care utilization_

Given lower public and private expenditures on health, healthcare utilization is of<sup>great</sup> concern. Indeed, official statistics suggests that health care utilization drops significantly in 1999. For instance, outpatient visits per person per year for most of the 1990s was consistently slightly above 8, and then fell sharply to just 5.6 in 1999. Also, like in most other country in the Region, in the 1990s there was a fall in the number of hospital beds. This fall, however, was particularly marked in 1999. In 1999, this number reached 825 beds per 10,000 people, down from 1,100 in 1998 and 1,150 in 1997. Other statistics<sup>like</sup> physician and hospital admissions per capita and the average length of hospital stays follow a similar trend (WHO, 2001).

In this section we look at the micro evidence on health care utilization available in the household budget survey and explore the correlated associated with a lower utilization rate. Although the survey is not rich in health care utilization, it collects information on the number of visits per month to health clinics and hospitals and the approximate distance (physical and in time) to this institutions, and we exploit this data.

Our data shows that clinics are far more commonly visited than hospitals in Moldova. From the 1,776 household in our sample, 560 households had at least one visit to a health clinic in the periods before the crisis. The number of households with, at least, one visit to a hospital is only 83, and 55 of these have also visited a clinic.

Table 4.21 reveals that before the crisis 33.5% of the households in Moldova visited at least once a health clinic or a hospital per month. And most households in visited clinics (31.9%) compared to hospitals (5.2%). For the period after the crisis, the percentage of households that had visited either a clinic or a hospital decrease almost 7 percentage point, from 33.5% to 26.8%. This represents a significant drop in utilization of 20%, relative to the utilization before the crisis. Most of this decrease comes from a decreased utilization of clinics. Clinic utilization drops 6 percentage points, while hospital utilization drops by (a non significant) 1 percentage point. In table 13 to 16 show hospital utilization rates that do not exceed 7 percentage points, and for which the pre and post crisis values do not differ statistically from each other in any of the cases. For this reason we concentrate on discussing the utilization to clinics, understanding that this is where most of the action occurs.

Dividing the population by quintile of initial expenditure shows that for all the quintile the post-crisis utilization rate is lower. However, except for the top quintile, utilization after the crisis cannot be found statistically different than utilization before the crisis. Standard errors across quintile are of about the same magnitude. But differences<sup>in</sup> utilization for the first 4 quintile are not large enough to make them significant, given the size of the standard errors. The top quintile's utilization drops to 28.4% after the crisis from a 40% prior the crisis-a significant drop of 31.5%.

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