Strained Mercy: The Quality of Medical Care in Delhi
The quality of medical care is a potentially important determinant of health outcomes. Nevertheless, it remains an understudied area. The limited research that exists defines quality either on the basis of drug availability or facility characterist...
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| Format: | Policy Research Working Paper |
| Language: | English en_US |
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World Bank, Washington, D.C.
2013
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| Online Access: | http://documents.worldbank.org/curated/en/2004/03/3957282/strained-mercy-quality-medical-care-delhi http://hdl.handle.net/10986/14725 |
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okr-10986-147252021-04-23T14:03:20Z Strained Mercy: The Quality of Medical Care in Delhi Das, Jishnu Hammer, Jeffrey S. MEDICAL CARE FOR THE POOR MEDICINE ALTERNATIVE MEDICINE PUBLIC HEALTH HEALTH CARE HEALTH CARE EQUITY HEALTH CARE ACCESS HEALTH CARE QUALITY CONTROL HEALTH CARE SECTOR QUALITY STANDARDS AILMENTS CLINICS COMPETENCE COUNSELING DEPRESSANTS DEPRESSION DOCTORS ECONOMICS EFFICACY OF TREATMENT EXPENDITURES FAMILIES FEE FOR SERVICE HEALTH CARE HEALTH OUTCOMES HEALTH POLICY HEALTH SECTOR HEALTH SERVICES HEALTH STATUS HIGH BLOOD PRESSURE HOSPITALS ILLNESSES INCOME LOW INCOME MARKET FAILURES MEDICAL CARE MEDICAL SERVICES MEDICINE MEDICINES ORAL REHYDRATION THERAPY PATIENT CARE PATIENT COMPLIANCE PATIENTS PHYSICIANS POLICY RESEARCH PREGNANCY PRIVATE SECTOR PROBABILITY PROVIDER INCENTIVES PUBLIC HOSPITALS PUBLIC SECTOR REASONING RECOGNITION SEXUALLY TRANSMITTED DISEASES SPECIALISTS SUICIDE THOUGHTS The quality of medical care is a potentially important determinant of health outcomes. Nevertheless, it remains an understudied area. The limited research that exists defines quality either on the basis of drug availability or facility characteristics, but little is known about how provider quality affects the provision of health care. The authors address this gap through a survey in Delhi with two related components. They evaluate "competence" (what providers know) through vignettes and practice (what providers do) through direct clinical observation. Overall quality as measured by the competence necessary to recognize and handle common and dangerous conditions is quite low, albeit with tremendous variation. While there is some correlation with simple observed characteristics, there is still an enormous amount of variation within such categories. Further, even when providers know what to do they often do not do it in practice. This appears to be true in both the public and private sectors though for very different, and systematic, reasons. In the public sector providers are more likely to commit errors of omission-they are less likely to exert effort compared with their private counterparts. In the private sector, providers are prone to errors of commission-they are more likely to behave according to the patient's expectations, resulting in the inappropriate use of medications, the overuse of antibiotics, and increased expenditures. This has important policy implications for our understanding of how market failures and failures of regulation in the health sector affect the poor. 2013-08-01T15:36:13Z 2013-08-01T15:36:13Z 2004-03 http://documents.worldbank.org/curated/en/2004/03/3957282/strained-mercy-quality-medical-care-delhi http://hdl.handle.net/10986/14725 English en_US Policy Research Working Paper;No.3228 CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo/ World Bank World Bank, Washington, D.C. Publications & Research :: Policy Research Working Paper Publications & Research South Asia India |
| repository_type |
Digital Repository |
| institution_category |
Foreign Institution |
| institution |
Digital Repositories |
| building |
World Bank Open Knowledge Repository |
| collection |
World Bank |
| language |
English en_US |
| topic |
MEDICAL CARE FOR THE POOR MEDICINE ALTERNATIVE MEDICINE PUBLIC HEALTH HEALTH CARE HEALTH CARE EQUITY HEALTH CARE ACCESS HEALTH CARE QUALITY CONTROL HEALTH CARE SECTOR QUALITY STANDARDS AILMENTS CLINICS COMPETENCE COUNSELING DEPRESSANTS DEPRESSION DOCTORS ECONOMICS EFFICACY OF TREATMENT EXPENDITURES FAMILIES FEE FOR SERVICE HEALTH CARE HEALTH OUTCOMES HEALTH POLICY HEALTH SECTOR HEALTH SERVICES HEALTH STATUS HIGH BLOOD PRESSURE HOSPITALS ILLNESSES INCOME LOW INCOME MARKET FAILURES MEDICAL CARE MEDICAL SERVICES MEDICINE MEDICINES ORAL REHYDRATION THERAPY PATIENT CARE PATIENT COMPLIANCE PATIENTS PHYSICIANS POLICY RESEARCH PREGNANCY PRIVATE SECTOR PROBABILITY PROVIDER INCENTIVES PUBLIC HOSPITALS PUBLIC SECTOR REASONING RECOGNITION SEXUALLY TRANSMITTED DISEASES SPECIALISTS SUICIDE THOUGHTS |
| spellingShingle |
MEDICAL CARE FOR THE POOR MEDICINE ALTERNATIVE MEDICINE PUBLIC HEALTH HEALTH CARE HEALTH CARE EQUITY HEALTH CARE ACCESS HEALTH CARE QUALITY CONTROL HEALTH CARE SECTOR QUALITY STANDARDS AILMENTS CLINICS COMPETENCE COUNSELING DEPRESSANTS DEPRESSION DOCTORS ECONOMICS EFFICACY OF TREATMENT EXPENDITURES FAMILIES FEE FOR SERVICE HEALTH CARE HEALTH OUTCOMES HEALTH POLICY HEALTH SECTOR HEALTH SERVICES HEALTH STATUS HIGH BLOOD PRESSURE HOSPITALS ILLNESSES INCOME LOW INCOME MARKET FAILURES MEDICAL CARE MEDICAL SERVICES MEDICINE MEDICINES ORAL REHYDRATION THERAPY PATIENT CARE PATIENT COMPLIANCE PATIENTS PHYSICIANS POLICY RESEARCH PREGNANCY PRIVATE SECTOR PROBABILITY PROVIDER INCENTIVES PUBLIC HOSPITALS PUBLIC SECTOR REASONING RECOGNITION SEXUALLY TRANSMITTED DISEASES SPECIALISTS SUICIDE THOUGHTS Das, Jishnu Hammer, Jeffrey S. Strained Mercy: The Quality of Medical Care in Delhi |
| geographic_facet |
South Asia India |
| relation |
Policy Research Working Paper;No.3228 |
| description |
The quality of medical care is a
potentially important determinant of health outcomes.
Nevertheless, it remains an understudied area. The limited
research that exists defines quality either on the basis of
drug availability or facility characteristics, but little is
known about how provider quality affects the provision of
health care. The authors address this gap through a survey
in Delhi with two related components. They evaluate
"competence" (what providers know) through
vignettes and practice (what providers do) through direct
clinical observation. Overall quality as measured by the
competence necessary to recognize and handle common and
dangerous conditions is quite low, albeit with tremendous
variation. While there is some correlation with simple
observed characteristics, there is still an enormous amount
of variation within such categories. Further, even when
providers know what to do they often do not do it in
practice. This appears to be true in both the public and
private sectors though for very different, and systematic,
reasons. In the public sector providers are more likely to
commit errors of omission-they are less likely to exert
effort compared with their private counterparts. In the
private sector, providers are prone to errors of
commission-they are more likely to behave according to the
patient's expectations, resulting in the inappropriate
use of medications, the overuse of antibiotics, and
increased expenditures. This has important policy
implications for our understanding of how market failures
and failures of regulation in the health sector affect the poor. |
| format |
Publications & Research :: Policy Research Working Paper |
| author |
Das, Jishnu Hammer, Jeffrey S. |
| author_facet |
Das, Jishnu Hammer, Jeffrey S. |
| author_sort |
Das, Jishnu |
| title |
Strained Mercy: The Quality of Medical Care in Delhi |
| title_short |
Strained Mercy: The Quality of Medical Care in Delhi |
| title_full |
Strained Mercy: The Quality of Medical Care in Delhi |
| title_fullStr |
Strained Mercy: The Quality of Medical Care in Delhi |
| title_full_unstemmed |
Strained Mercy: The Quality of Medical Care in Delhi |
| title_sort |
strained mercy: the quality of medical care in delhi |
| publisher |
World Bank, Washington, D.C. |
| publishDate |
2013 |
| url |
http://documents.worldbank.org/curated/en/2004/03/3957282/strained-mercy-quality-medical-care-delhi http://hdl.handle.net/10986/14725 |
| _version_ |
1764430300103835648 |