Inequality in the Quality of Health Services: Wealth, Content of Care, and Price of Antenatal Consultations in the Democratic Republic of Congo

38 Pages Posted: 16 Apr 2019

See all articles by Gunther Fink

Gunther Fink

University of Basel - Swiss Tropical and Public Health Institute

Eeshani Kandpal

World Bank

Gil Shapira

The World Bank

Date Written: April 15, 2019

Abstract

Using unique direct observations of patient-provider interactions linked to patient exit interviews and detailed household surveys, this paper assesses the relationship between patient wealth and the quality and price of antenatal care in the Democratic Republic of Congo. Overall, the analysis finds a significant wealth-quality gradient, with a standard deviation increase in wealth being associated with an increase of 4 percentage points in protocol compliance. This increase in compliance represents 8 percent of the average quality of care received by women in the lowest wealth quintile. Over half of the wealth-quality gradient is driven by lower facility quality in poorer areas. However, the analysis also finds statistically significant within-village and even within-facility wealth-quality relationships. Within villages, wealth-quality gradients are primarily driven by wealthier women seeking care at higher-quality even if more distant facilities. Within the same facilities, poorer women tend to receive worse care, but on average they also pay less for the same quality of care compared with wealthier women. The price gap increases in the local ratio of wealthy to poor households, suggesting that providers do not charge different prices only for redistributive reasons.

Suggested Citation

Fink, Gunther and Kandpal, Eeshani and Shapira, Gil, Inequality in the Quality of Health Services: Wealth, Content of Care, and Price of Antenatal Consultations in the Democratic Republic of Congo (April 15, 2019). World Bank Policy Research Working Paper No. 8818, Available at SSRN: https://ssrn.com/abstract=3372630

Gunther Fink (Contact Author)

University of Basel - Swiss Tropical and Public Health Institute ( email )

Basel
Switzerland

Eeshani Kandpal

World Bank ( email )

1818 H Street, NW
Washington, DC 20433
United States

Gil Shapira

The World Bank ( email )

1818 H. Street, N.W.
MSN3-311
Washington, DC 20433
United States

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