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

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Author Info
Das, Jishnu
Hammer, Jeffrey

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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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Paper provided by The World Bank in its series Policy Research Working Paper Series with number 3669.

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Date of creation: 01 Jul 2005
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Handle: RePEc:wbk:wbrwps:3669

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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. Daniel A. Ackerberg & Maristella Botticini, 2002. "Endogenous Matching and the Empirical Determinants of Contract Form," Journal of Political Economy, University of Chicago Press, vol. 110(3), pages 564-591, June. [Downloadable!] (restricted)
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  2. Abhijit Banerjee & Angus Deaton & Esther Duflo, 2004. "Wealth, Health, and Health Services in Rural Rajasthan," American Economic Review, American Economic Association, vol. 94(2), pages 326-330, May. [Downloadable!]
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  3. Chaudhury, Nazmul & Hammer, Jeffrey S., 2003. "Ghost doctors - absenteeism in Bangladeshi health facilities," Policy Research Working Paper Series 3065, The World Bank. [Downloadable!]
  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. [Downloadable!]
  5. Mattoo, Aaditya & Rathindran, Randeep, 2005. "Does health insurance impede trade inhealth care services?," Policy Research Working Paper Series 3667, The World Bank. [Downloadable!]
  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. [Downloadable!] (restricted)
  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. Das, Jishnu & Hammer, Jeffrey, 2004. "Strained mercy : The quality of medical care in Delhi," Policy Research Working Paper Series 3228, The World Bank. [Downloadable!]
  9. Paul Collier & Stefan Dercon & John Mackinnon, 2004. "Density versus Quality in Health Care Provision: Using Household Data to Make Budgetary Choices in Ethiopia," Development and Comp Systems 0409052, EconWPA. [Downloadable!]
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(explanations, 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. Jack, William & Lewis, Maureen, 2009. "Health investments and economic growth : macroeconomic evidence and microeconomic foundations," Policy Research Working Paper Series 4877, The World Bank. [Downloadable!]
  2. 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. [Downloadable!]
  3. 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. [Downloadable!]
  4. Singh, Nirvikar, 2008. "Decentralization and Public Delivery of Health Care Services in India," MPRA Paper 7869, University Library of Munich, Germany. [Downloadable!]
  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. [Downloadable!]
  6. Abhijit Banerjee, 2008. "What is Middle Class About the Middle Classes Around the World?," Working Papers id:1363, esocialsciences.com. [Downloadable!]
  7. Das, Jishnu & Hammer, Jeffrey, 2004. "Strained mercy : The quality of medical care in Delhi," Policy Research Working Paper Series 3228, The World Bank. [Downloadable!]
  8. 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. [Downloadable!]
  9. Anonymous, 2006. "An Examination of the Relationship between Health and Economic Growth," Working Papers id:738, esocialsciences.com. [Downloadable!]
  10. Das, Jishnu & Hammer, Jeffrey & Leonard, Kenneth, 2008. "The quality of medical advice in low-income countries," Policy Research Working Paper Series 4501, The World Bank. [Downloadable!]
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