Quality of Primary Care in Low-Income Countries: Facts and Economics

Posted: 8 Aug 2014

See all articles by Jishnu Das

Jishnu Das

Georgetown University; Georgetown University

Jeffrey S. Hammer

Princeton University - Woodrow Wilson School of Public and International Affairs

Date Written: August 2014

Abstract

New research on the quality of care in public and private primary care facilities has significantly enriched our understanding of how health care is delivered in low- and middle-income countries. First, this article summarizes recent advances in the measurement of quality, distinguishing between measurements of provider knowledge and provider effort. Second, it looks at the determinants of practice quality variation in low-income settings, highlighting the limited role of structural constraints such as infrastructure, the supply of materials including drugs, and provider training - the mainstay of much of global health policy today. In contrast, practice quality variation is clearly linked to provider effort, an aspect of provider behavior that can be altered through a variety of means. Third, it provides a broad economic framework to interpret the findings. We look for evidence of specific market failures in the provision of primary care and emphasize that the key difficulty is (and always was) the transaction-specific nature of medical advice. Providers can do too much or too little (or both), and the extent of either depends on the specific patient and the specific disease. We document specific ways in which it is difficult for both consumers and governments to monitor every transaction to detect potentially errant behavior.

Suggested Citation

Das, Jishnu and Hammer, Jeffrey S., Quality of Primary Care in Low-Income Countries: Facts and Economics (August 2014). Annual Review of Economics, Vol. 6, pp. 525-553, 2014, Available at SSRN: https://ssrn.com/abstract=2477777 or http://dx.doi.org/10.1146/annurev-economics-080213-041350

Jishnu Das (Contact Author)

Georgetown University ( email )

O Street
Washington, DC 20057
United States

Georgetown University ( email )

Old North, Suite 100
37th & O Streets NW
Washington, DC 20057
United States

Jeffrey S. Hammer

Princeton University - Woodrow Wilson School of Public and International Affairs ( email )

Princeton University
Princeton, NJ 08544-1021
United States

Here is the Coronavirus
related research on SSRN

Paper statistics

Abstract Views
238
PlumX Metrics