Quality and Accountability in Healthcare Delivery : Audit Evidence from Primary Care Providers in India
This paper presents direct evidence on the quality of health care in low-income settings using a unique and original set of audit studies, where standardized patients were presented to a nearly representative sample of rural public and private prim...
| Main Authors: | , , , |
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| Format: | Working Paper |
| Language: | English en_US |
| Published: |
World Bank, Washington, DC
2015
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| Subjects: | |
| Online Access: | http://documents.worldbank.org/curated/en/2015/06/24689973/quality-accountability-healthcare-delivery-audit-evidence-primary-care-providers-india http://hdl.handle.net/10986/22215 |
| Summary: | This paper presents direct evidence on
the quality of health care in low-income settings using a
unique and original set of audit studies, where standardized
patients were presented to a nearly representative sample of
rural public and private primary care providers in the
Indian state of Madhya Pradesh. Three main findings are
reported. First, private providers are mostly unqualified,
but they spent more time with patients and completed more
items on a checklist of essential history and examination
items than public providers, while being no different in
their diagnostic and treatment accuracy. Second, the private
practices of qualified public sector doctors were identified
and the same doctors exerted higher effort and were more
likely to provide correct treatment in their private
practices. Third, there is a strong positive correlation
between provider effort and prices charged in the private
sector, whereas there is no correlation between effort and
wages in the public sector. The results suggest that
market-based accountability in the unregulated private
sector may be providing better incentives for provider
effort than administrative accountability in the public
sector in this setting. While the overall quality of care is
low both sectors, the differences in provider effort may
partly explain the dominant market share of fee-charging
private providers even in the presence of a system of free
public healthcare. |
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