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

77 Pages Posted: 3 Aug 2015

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: July 2015

Abstract

We present the first direct evidence on the relative quality of public and private healthcare in a low-income setting, using a unique set of audit studies. We sent standardized (fake) patients to rural primary care providers in the Indian state of Madhya Pradesh, and recorded the quality of care provided and prices charged in each interaction. We report three main findings. First, most private providers lacked formal medical training, but they spent more time with patients and completed more essential checklist items than public providers, and were equally likely to provide a correct treatment. Second, we compare the performance of qualified public doctors across their public and private practices, and find that the same doctors exerted higher effort and were more likely to provide a correct treatment in their private practices. Third, in the private sector, we find that prices charged are positively correlated with provider effort and correct treatment, but also with unnecessary treatments. In the public sector, we find no correlation between provider salaries and any measure of quality. We develop a simple theoretical framework to interpret our results and show that in settings with low levels of effort in the public sector, the benefits of higher diagnostic effort in the private sector may outweigh the costs of market incentives to over treat. These 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.

Suggested Citation

Das, Jishnu and Holla, Alaka and Mohpal, Aakash and Muralidharan, Karthik, Quality and Accountability in Healthcare Delivery: Audit-Study Evidence from Primary Care in India (July 2015). NBER Working Paper No. w21405, Available at SSRN: https://ssrn.com/abstract=2638960

Jishnu Das (Contact Author)

Georgetown University ( email )

O Street
Washington, DC 20057
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Georgetown University ( email )

Old North, Suite 100
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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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