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The Structural Quality of Health Services as a Potential Constraint for Human Capital Accumulation

One key assumption underlying interventions and policies aiming to promote development by increasing the accumulation of human capital, particularly health capital, is that increasing access to and utilisation of health services will translate into health capital. This assumption, from Grossman´s health capital model, assumes that both preventive and curative health services improve health status and thus increase its level. The ability of health services to generate health is related to their quality. In terms of analysing the quality of health services, structural quality could be viewed as a necessary but not sufficient component of quality; having areas, equipment, supplies and medicine to offer health services is a requirement to offer care, and thus, analysing structural quality provides a basic measure of the ability of health services to effectively generate health. While there is an important amount of literature regarding quality of health services, empirical analysis of structural quality are limited as are those related this dimension of quality and outcome indicators. In this chapter, I present the first published analysis on structural quality of primary health services in Mexico and show large heterogeneity in structural quality that is negatively correlated with general living conditions, meaning that the poorest are served by the lowest level of structural quality facilities, and some indication that poor quality is related to higher infant mortality rate. Improving structural quality is required if development is sought.