Quality and Accountability in Healthcare Delivery: Audit Evidence from Primary Care Providers in India

77 Pages Posted: 20 Apr 2016

See all articles by Jishnu Das

Jishnu Das

Georgetown University; Georgetown University

Alaka Holla

World Bank; Brown University; Innovations for Poverty Action

Aakash Mohpal

University of Michigan at Ann Arbor

Karthik Muralidharan

University of California, San Diego (UCSD)

Date Written: June 23, 2015

Abstract

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.

Keywords: Health Economics & Finance, De Facto Governments, Democratic Government, Public Sector Administrative and Civil Service Reform, Economics and Finance of Public Institution Development, Public Sector Administrative & Civil Service Reform

Suggested Citation

Das, Jishnu and Holla, Alaka and Mohpal, Aakash and Muralidharan, Karthik, Quality and Accountability in Healthcare Delivery: Audit Evidence from Primary Care Providers in India (June 23, 2015). World Bank Policy Research Working Paper No. 7334. Available at SSRN: https://ssrn.com/abstract=2622320

Jishnu Das (Contact Author)

Georgetown University ( email )

O Street
Washington, DC 20057
United States

Georgetown University ( email )

Old North, Suite 100
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Washington, DC 20057
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Alaka Holla

World Bank ( email )

1818 H Street NW
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Brown University ( email )

Box 1860
Providence, RI 02912
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Innovations for Poverty Action ( email )

1731 Connecticut Ave, 4th floor
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Aakash Mohpal

University of Michigan at Ann Arbor ( email )

500 S. State Street
Ann Arbor, MI 48109
United States

Karthik Muralidharan

University of California, San Diego (UCSD) ( email )

9500 Gilman Drive
Mail Code 0502
La Jolla, CA 92093-0112
United States

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