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Money for nothing: The dire straits of medical practice in Delhi, India

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  • Das, Jishnu
  • Hammer, Jeffrey

Abstract

The quality of medical care received by patients varies for two reasons: differences in doctors'competence or differences in doctors'incentives. Using medical vignettes, the authors evaluated competence for a sample of doctors in Delhi. One month later, they observed the same doctors in their practice. The authors find three patterns in the data. First, what doctors do is less than what they know they should do-doctors operate well inside their knowledge frontier. Second, competence and effort are complementary so that doctors who know more also do more. Third, the gap between what doctors do and what they know responds to incentives: doctors in the fee-for-service private sector are closer in practice to their knowledge frontier than those in the fixed-salary public sector. Under-qualified private sector doctors, even though they know less, provide better care on average than their better-qualified counterparts in the public sector. These results indicate that to improve medical services, at least for poor people, there should be greater emphasis on changing the incentives of public providers rather than increasing provider competence through training.

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Bibliographic Info

Article provided by Elsevier in its journal Journal of Development Economics.

Volume (Year): 83 (2007)
Issue (Month): 1 (May)
Pages: 1-36
Download reference. The following formats are available: HTML (with abstract), plain text (with abstract), BibTeX, RIS (EndNote, RefMan, ProCite), ReDIF
Handle: RePEc:eee:deveco:v:83:y:2007:i:1:p:1-36

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References

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Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
  1. Abhijit Banerjee & Angus Deaton & Esther Duflo, 2003. "Wealth, health, and health services in rural Rajasthan," Working Papers 253, Princeton University, Woodrow Wilson School of Public and International Affairs, Center for Health and Wellbeing..
  2. Daniel A. Ackerberg & Maristella Botticini, 1999. "Endogenous Matching and the Empirical Determinants of Contract Form," Papers 0096, Boston University - Industry Studies Programme.
  3. Chaudhury, Nazmul & Hammer, Jeffrey S., 2003. "Ghost doctors - absenteeism in Bangladeshi health facilities," Policy Research Working Paper Series 3065, The World Bank.
  4. Das, Jishnu & Sanchez-Paramo, Carolina, 2003. "Short but not sweet - new evidence on short duration morbidities from India," Policy Research Working Paper Series 2971, The World Bank.
  5. Mattoo, Aaditya & Rathindran, Randeep, 2005. "Does health insurance impede trade inhealth care services?," Policy Research Working Paper Series 3667, The World Bank.
  6. Das, Jishnu & Hammer, Jeffrey, 2005. "Which doctor? Combining vignettes and item response to measure clinical competence," Journal of Development Economics, Elsevier, vol. 78(2), pages 348-383, December.
  7. Martin Gaynor & James B. Rebitzer & Lowell J. Taylor, 2004. "Physician Incentives in Health Maintenance Organizations," Journal of Political Economy, University of Chicago Press, vol. 112(4), pages 915-931, August.
  8. Paul Collier & Stefan Dercon & John Mackinnon, 2002. "Density versus Quality in Health Care Provision: Using Household Data to Make Budgetary Choices in Ethiopia," World Bank Economic Review, Oxford University Press, vol. 16(3), pages 425-448, December.
  9. Redding, Stephen & Sturm, Daniel.M, 2005. "Location, location, location," Open Access publications from London School of Economics and Political Science http://eprints.lse.ac.uk/, London School of Economics and Political Science.
  10. Das, Jishnu & Hammer, Jeffrey, 2004. "Strained mercy : The quality of medical care in Delhi," Policy Research Working Paper Series 3228, The World Bank.
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Citations

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Cited by:
  1. Jishnu Das, 2011. "The Quality of Medical Care in Low-Income Countries: From Providers to Markets," Working Papers id:3955, eSocialSciences.
  2. Das, Jishnu & Hammer, Jeffrey, 2004. "Which doctor? Combining vignettes and item response to measure doctor quality," Policy Research Working Paper Series 3301, The World Bank.
  3. Erlend Berg & Maitreesh Ghatak & R Manjula & D Rajasekhar & Sanchari Roy, 2011. "Implementing Health Insurance For The Poor: The Rollout Of Rsby In Karnataka," STICERD - Economic Organisation and Public Policy Discussion Papers Series 025, Suntory and Toyota International Centres for Economics and Related Disciplines, LSE.
  4. Garima Malik, 2006. "An Examination of the Relationship between Health and Economic Growth," Macroeconomics Working Papers 22173, East Asian Bureau of Economic Research.
  5. Klemick, Heather & Leonard, Kenneth L. & Masatu, Melkiory C., 2008. "Defining Access to Health Care: Evidence on the Importance of Quality and Distance in Rural Tanzania," Working Papers 6178, University of Maryland, Department of Agricultural and Resource Economics.
  6. Ottar Mæstad & Gaute Torsvik, 2008. "Improving the Quality of Health Care when Health Workers are in Short Supply," CMI Working Papers 12, CMI (Chr. Michelsen Institute), Bergen, Norway.
  7. Esther Duflo & Abhijit Banerjee, 2008. "What is Middle Class About the Middle Classes Around the World?," Working Papers id:1363, eSocialSciences.
  8. Jack, William & Lewis, Maureen, 2009. "Health investments and economic growth : macroeconomic evidence and microeconomic foundations," Policy Research Working Paper Series 4877, The World Bank.
  9. Jishnu Das & Jeffrey Hammer & Kenneth Leonard, 2008. "The Quality of Medical Advice in Low-Income Countries," Journal of Economic Perspectives, American Economic Association, vol. 22(2), pages 93-114, Spring.
  10. Grant Miller & Diana M. Pinto & Marcos Vera-Hernández, 2009. "High-Powered Incentives in Developing Country Health Insurance: Evidence from Colombia’s Régimen Subsidiado," NBER Working Papers 15456, National Bureau of Economic Research, Inc.
  11. Yusuke Kamiya, 2010. "Determinants of Health in Developing Countries:Cross-Country Evidence," OSIPP Discussion Paper 10E009, Osaka School of International Public Policy, Osaka University.
  12. Das, Jishnu & Sohnesen, Thomas Pave, 2006. "Patient satisfaction, doctor effort, and interview location : evidence from Paraguay," Policy Research Working Paper Series 4086, The World Bank.
  13. Singh, Nirvikar, 2008. "Decentralization and Public Delivery of Health Care Services in India," MPRA Paper 7869, University Library of Munich, Germany.
  14. Kenneth L. Leonard & Melkiory C. Masatu & Alexandre Vialou, 2007. "Getting Doctors to Do Their Best: The Roles of Ability and Motivation in Health Care Quality," Journal of Human Resources, University of Wisconsin Press, vol. 42(3).
  15. Lewis, Maureen & Pettersson, Gunilla, 2009. "Governance in health care delivery : raising performance," Policy Research Working Paper Series 5074, The World Bank.
  16. Garima Malik, 2006. "An Examination of the relationship between Health and Economic Growth," Indian Council for Research on International Economic Relations, New Delhi Working Papers 185, Indian Council for Research on International Economic Relations, New Delhi, India.
  17. Jishnu Das & Jeffrey Hammer & Carolina Sánchez-Paramo, 2011. "The Impact of Recall Periods on Reported Morbidity and Health Seeking Behavior," Working Papers 1320, Princeton University, Woodrow Wilson School of Public and International Affairs, Research Program in Development Studies..
  18. Sonia Bhalotra & Irma Clots-Figueras, 2011. "Health and the Political Agency of Women," The Centre for Market and Public Organisation 11/280, Department of Economics, University of Bristol, UK.
  19. Das, Jishnu & Hammer, Jeffrey, 2004. "Strained mercy : The quality of medical care in Delhi," Policy Research Working Paper Series 3228, The World Bank.
  20. Shinsuke Tanaka, 2008. "Access to Health Infrastructure and Child Health Development: Evidence from Post-Apartheid South Africa," ISER Discussion Paper 0768, Institute of Social and Economic Research, Osaka University, revised Jan 2010.

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