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Getting Doctors to Do Their Best: The Roles of Ability and Motivation in Health Care Quality

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  • Kenneth L. Leonard
  • Melkiory C. Masatu
  • Alexandre Vialou

Abstract

Adherence to medical protocol (quality) is low in most developing countries. We show that, although the differences in knowledge of protocol among doctors in Arusha region of Tanzania are explained by years of training, the differences in actual adherence to protocol and the gap between knowledge and actual adherence are best understood by examining the types of organizations in which these doctors work. These results suggest that some organizations are better at getting doctors to perform at capacity and that understanding the link between organizational structure and protocol adherence is important in any attempt to increase the quality of care.

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Bibliographic Info

Article provided by University of Wisconsin Press in its journal Journal of Human Resources.

Volume (Year): 42 (2007)
Issue (Month): 3 ()
Pages:

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Handle: RePEc:uwp:jhriss:v:42:y:2007:i3:p682-700

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References

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  1. Das, Jishnu & Hammer, Jeffrey, 2007. "Money for nothing: The dire straits of medical practice in Delhi, India," Journal of Development Economics, Elsevier, Elsevier, vol. 83(1), pages 1-36, May.
  2. Chaudhury, Nazmul & Hammer, Jeffrey S., 2003. "Ghost doctors - absenteeism in Bangladeshi health facilities," Policy Research Working Paper Series, The World Bank 3065, The World Bank.
  3. Das, Jishnu & Hammer, Jeffrey, 2004. "Which doctor? Combining vignettes and item response to measure doctor quality," Policy Research Working Paper Series, The World Bank 3301, The World Bank.
  4. Bengt Holmstrom, 1981. "Moral Hazard in Teams," Discussion Papers, Northwestern University, Center for Mathematical Studies in Economics and Management Science 471, Northwestern University, Center for Mathematical Studies in Economics and Management Science.
  5. Tomas Philipson, 1996. "Private Vaccination and Public Health: An Empirical Examination for U.S. Measles," Journal of Human Resources, University of Wisconsin Press, University of Wisconsin Press, vol. 31(3), pages 611-630.
  6. Reinikka, Ritva & Svensson, Jakob, 2004. "Working for God?," CEPR Discussion Papers, C.E.P.R. Discussion Papers 4214, C.E.P.R. Discussion Papers.
  7. Schultz, T. Paul & Tansel, Aysit, 1997. "Wage and labor supply effects of illness in Cote d'Ivoire and Ghana: instrumental variable estimates for days disabled," Journal of Development Economics, Elsevier, Elsevier, vol. 53(2), pages 251-286, August.
  8. Rosenzweig, Mark R. & Pitt, Mark M., 1984. "Agricultural Prices, Food Consumption and the Health and Productivity of Farmers," Bulletins, University of Minnesota, Economic Development Center 7471, University of Minnesota, Economic Development Center.
  9. Bhargava, Alok & Jamison, Dean T. & Lau, Lawrence J. & Murray, Christopher J. L., 2001. "Modeling the effects of health on economic growth," Journal of Health Economics, Elsevier, Elsevier, vol. 20(3), pages 423-440, May.
  10. Leonard, Kenneth & Masatu, Melkiory C., 2006. "Outpatient process quality evaluation and the Hawthorne Effect," Social Science & Medicine, Elsevier, Elsevier, vol. 63(9), pages 2330-2340, November.
  11. Leonard, Kenneth L., 2002. "When both states and markets fail: asymmetric information and the role of NGOs in African health care," International Review of Law and Economics, Elsevier, Elsevier, vol. 22(1), pages 61-80, July.
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Citations

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Cited by:
  1. Ottar Mæstad & Gaute Torsvik, 2008. "Improving the Quality of Health Care when Health Workers are in Short Supply," CMI Working Papers, CMI (Chr. Michelsen Institute), Bergen, Norway 12, CMI (Chr. Michelsen Institute), Bergen, Norway.
  2. 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, University of Maryland, Department of Agricultural and Resource Economics 6178, University of Maryland, Department of Agricultural and Resource Economics.
  3. Leonard, David K. & Bloom, Gerald & Hanson, Kara & O’Farrell, Juan & Spicer, Neil, 2013. "Institutional Solutions to the Asymmetric Information Problem in Health and Development Services for the Poor," World Development, Elsevier, Elsevier, vol. 48(C), pages 71-87.
  4. Michael A. Clemens, 2009. "Skill Flow: A Fundamental Reconsideration of Skilled-Worker Mobility and Development," Human Development Research Papers (2009 to present), Human Development Report Office (HDRO), United Nations Development Programme (UNDP) HDRP-2009-08, Human Development Report Office (HDRO), United Nations Development Programme (UNDP), revised Apr 2009.
  5. Lange, Siri & Mwisongo, Aziza & Mæstad, Ottar, 2014. "Why don't clinicians adhere more consistently to guidelines for the Integrated Management of Childhood Illness (IMCI)?," Social Science & Medicine, Elsevier, Elsevier, vol. 104(C), pages 56-63.
  6. Jishnu Das & Jeffrey Hammer & Carolina Sánchez-Paramo, 2011. "The Impact of Recall Periods on Reported Morbidity and Health Seeking Behavior," Working Papers, Princeton University, Woodrow Wilson School of Public and International Affairs, Research Program in Development Studies. 1320, Princeton University, Woodrow Wilson School of Public and International Affairs, Research Program in Development Studies..
  7. Abigail Barr & Danila Serra and Pieter Serneels, 2010. "Intrinsic motivations and the non-profit health sector: Evidence from Ethiopia," Economics Series Working Papers, University of Oxford, Department of Economics CSAE WPS/2010-04, University of Oxford, Department of Economics.
  8. Mæstad, Ottar & Torsvik, Gaute & Aakvik, Arild, 2010. "Overworked? On the relationship between workload and health worker performance," Journal of Health Economics, Elsevier, Elsevier, vol. 29(5), pages 686-698, September.
  9. Das, Jishnu & Hammer, Jeffrey & Leonard, Kenneth, 2008. "The quality of medical advice in low-income countries," Policy Research Working Paper Series, The World Bank 4501, The World Bank.
  10. Leonard, Kenneth L., 2009. "The cost of imperfect agency in health care: Evidence from rural Cameroun," Journal of Development Economics, Elsevier, Elsevier, vol. 88(2), pages 282-291, March.
  11. J. Michelle Brock & Andreas Lange & Kenneth L. Leonard, 2014. "Giving and promising gifts: experimental evidence on reciprocity from the field," Working Papers, European Bank for Reconstruction and Development, Office of the Chief Economist 165, European Bank for Reconstruction and Development, Office of the Chief Economist.
  12. Jishnu Das, 2011. "The Quality of Medical Care in Low-Income Countries: From Providers to Markets," Working Papers id:3955, eSocialSciences.

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