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...
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| Format: | Working Paper |
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World Bank, Washington, DC
2015
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| 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 |
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okr-10986-222152021-04-23T14:04:07Z Quality and Accountability in Healthcare Delivery : Audit Evidence from Primary Care Providers in India Das, Jishnu Holla, Alaka Mohpal, Aakash Muralidharan, Karthik MEDICAL PRACTICE CHILD HEALTH RISKS TREATMENT DIAGNOSIS MARKET STRUCTURE CHRONIC DISEASES INFORMED CONSENT PEOPLE VACCINATION PHARMACISTS SALES ASTHMA MARKET INCENTIVE MORBIDITY ALLERGIES COMMUNITY HEALTH PRICE SETTING HEALTH SURVEYS HEALTH CARE EFFECTS CHILDHOOD ILLNESS HEALTH DISTRIBUTION HEALTH WORKERS PRICING MALARIA TREATMENTS PRICE DYSENTERY DEHYDRATION CESAREAN SECTION ALLOPATHIC MEDICINE PUBLIC HEALTH MARKET INCENTIVES RADIATION KNOWLEDGE VIRAL INFECTION DIABETES LABOR MARKET ANALGESICS PAIN ABDOMINAL PAIN DISEASES LIFE PATIENT PATIENTS SMOKING ORAL REHYDRATION ORT MEDICAL SCIENCES NURSES OBSERVATION BARRIERS TO ENTRY MARKETS ANXIETY ANGINA HAZARD MEDICAL CARE ORAL REHYDRATION SALTS TUBERCULOSIS PRODUCT SYMPTOMS VOMITING PRICE SUBSIDIES MORTALITY MEDICAL TREATMENT EXPENDITURE DIAGNOSES SUBSTITUTE WORKERS FEVER MEDICAL ATTENTION SURGERY AGED MARKET PRICES VALUE HEALTH POLICY MEDICINE HEALTH OUTCOMES DEMAND DIARRHEA SALE MEASUREMENT NUTRITION INJURIES MARKET MEDICAL OFFICER WORKSHOPS SYRINGES MALARIA SICK LEAVE LIVER REST PRIMARY HEALTH CARE PRICE DISCRIMINATION INTERNET ULCER RISK FACTORS OUTPATIENT CARE WEIGHT PHYSICIANS EXERCISE CHILDREN MARKET SHARE DISEASE DRINKING WATER CLINICS MARKET EQUILIBRIUM NAUSEA INFECTION GENERAL PRACTITIONERS SUPPLY RESPIRATORY DISEASES INFECTIONS MATERNAL AND CHILD HEALTH HEART ATTACK MYOCARDIAL INFARCTION WEIGHT LOSS STRATEGY CHILD HEALTH SERVICES SUPPLIERS MEDICINES HOSPITALS LABOR MARKETS ILLNESSES PATIENT CHOICE HEADACHE HEALTH SERVICES PREGNANCY PRICES NURSING 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. 2015-07-17T18:42:42Z 2015-07-17T18:42:42Z 2015-06 Working Paper 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 English en_US Policy Research Working Paper;No. 7334 CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo/ World Bank World Bank, Washington, DC Publications & Research Publications & Research :: Policy Research Working Paper 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 PRACTICE CHILD HEALTH RISKS TREATMENT DIAGNOSIS MARKET STRUCTURE CHRONIC DISEASES INFORMED CONSENT PEOPLE VACCINATION PHARMACISTS SALES ASTHMA MARKET INCENTIVE MORBIDITY ALLERGIES COMMUNITY HEALTH PRICE SETTING HEALTH SURVEYS HEALTH CARE EFFECTS CHILDHOOD ILLNESS HEALTH DISTRIBUTION HEALTH WORKERS PRICING MALARIA TREATMENTS PRICE DYSENTERY DEHYDRATION CESAREAN SECTION ALLOPATHIC MEDICINE PUBLIC HEALTH MARKET INCENTIVES RADIATION KNOWLEDGE VIRAL INFECTION DIABETES LABOR MARKET ANALGESICS PAIN ABDOMINAL PAIN DISEASES LIFE PATIENT PATIENTS SMOKING ORAL REHYDRATION ORT MEDICAL SCIENCES NURSES OBSERVATION BARRIERS TO ENTRY MARKETS ANXIETY ANGINA HAZARD MEDICAL CARE ORAL REHYDRATION SALTS TUBERCULOSIS PRODUCT SYMPTOMS VOMITING PRICE SUBSIDIES MORTALITY MEDICAL TREATMENT EXPENDITURE DIAGNOSES SUBSTITUTE WORKERS FEVER MEDICAL ATTENTION SURGERY AGED MARKET PRICES VALUE HEALTH POLICY MEDICINE HEALTH OUTCOMES DEMAND DIARRHEA SALE MEASUREMENT NUTRITION INJURIES MARKET MEDICAL OFFICER WORKSHOPS SYRINGES MALARIA SICK LEAVE LIVER REST PRIMARY HEALTH CARE PRICE DISCRIMINATION INTERNET ULCER RISK FACTORS OUTPATIENT CARE WEIGHT PHYSICIANS EXERCISE CHILDREN MARKET SHARE DISEASE DRINKING WATER CLINICS MARKET EQUILIBRIUM NAUSEA INFECTION GENERAL PRACTITIONERS SUPPLY RESPIRATORY DISEASES INFECTIONS MATERNAL AND CHILD HEALTH HEART ATTACK MYOCARDIAL INFARCTION WEIGHT LOSS STRATEGY CHILD HEALTH SERVICES SUPPLIERS MEDICINES HOSPITALS LABOR MARKETS ILLNESSES PATIENT CHOICE HEADACHE HEALTH SERVICES PREGNANCY PRICES NURSING |
| spellingShingle |
MEDICAL PRACTICE CHILD HEALTH RISKS TREATMENT DIAGNOSIS MARKET STRUCTURE CHRONIC DISEASES INFORMED CONSENT PEOPLE VACCINATION PHARMACISTS SALES ASTHMA MARKET INCENTIVE MORBIDITY ALLERGIES COMMUNITY HEALTH PRICE SETTING HEALTH SURVEYS HEALTH CARE EFFECTS CHILDHOOD ILLNESS HEALTH DISTRIBUTION HEALTH WORKERS PRICING MALARIA TREATMENTS PRICE DYSENTERY DEHYDRATION CESAREAN SECTION ALLOPATHIC MEDICINE PUBLIC HEALTH MARKET INCENTIVES RADIATION KNOWLEDGE VIRAL INFECTION DIABETES LABOR MARKET ANALGESICS PAIN ABDOMINAL PAIN DISEASES LIFE PATIENT PATIENTS SMOKING ORAL REHYDRATION ORT MEDICAL SCIENCES NURSES OBSERVATION BARRIERS TO ENTRY MARKETS ANXIETY ANGINA HAZARD MEDICAL CARE ORAL REHYDRATION SALTS TUBERCULOSIS PRODUCT SYMPTOMS VOMITING PRICE SUBSIDIES MORTALITY MEDICAL TREATMENT EXPENDITURE DIAGNOSES SUBSTITUTE WORKERS FEVER MEDICAL ATTENTION SURGERY AGED MARKET PRICES VALUE HEALTH POLICY MEDICINE HEALTH OUTCOMES DEMAND DIARRHEA SALE MEASUREMENT NUTRITION INJURIES MARKET MEDICAL OFFICER WORKSHOPS SYRINGES MALARIA SICK LEAVE LIVER REST PRIMARY HEALTH CARE PRICE DISCRIMINATION INTERNET ULCER RISK FACTORS OUTPATIENT CARE WEIGHT PHYSICIANS EXERCISE CHILDREN MARKET SHARE DISEASE DRINKING WATER CLINICS MARKET EQUILIBRIUM NAUSEA INFECTION GENERAL PRACTITIONERS SUPPLY RESPIRATORY DISEASES INFECTIONS MATERNAL AND CHILD HEALTH HEART ATTACK MYOCARDIAL INFARCTION WEIGHT LOSS STRATEGY CHILD HEALTH SERVICES SUPPLIERS MEDICINES HOSPITALS LABOR MARKETS ILLNESSES PATIENT CHOICE HEADACHE HEALTH SERVICES PREGNANCY PRICES NURSING Das, Jishnu Holla, Alaka Mohpal, Aakash Muralidharan, Karthik Quality and Accountability in Healthcare Delivery : Audit Evidence from Primary Care Providers in India |
| geographic_facet |
South Asia India |
| relation |
Policy Research Working Paper;No. 7334 |
| description |
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. |
| format |
Working Paper |
| author |
Das, Jishnu Holla, Alaka Mohpal, Aakash Muralidharan, Karthik |
| author_facet |
Das, Jishnu Holla, Alaka Mohpal, Aakash Muralidharan, Karthik |
| author_sort |
Das, Jishnu |
| title |
Quality and Accountability in Healthcare Delivery : Audit Evidence from Primary Care Providers in India |
| title_short |
Quality and Accountability in Healthcare Delivery : Audit Evidence from Primary Care Providers in India |
| title_full |
Quality and Accountability in Healthcare Delivery : Audit Evidence from Primary Care Providers in India |
| title_fullStr |
Quality and Accountability in Healthcare Delivery : Audit Evidence from Primary Care Providers in India |
| title_full_unstemmed |
Quality and Accountability in Healthcare Delivery : Audit Evidence from Primary Care Providers in India |
| title_sort |
quality and accountability in healthcare delivery : audit evidence from primary care providers in india |
| publisher |
World Bank, Washington, DC |
| publishDate |
2015 |
| url |
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 |
| _version_ |
1764450444990480384 |