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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.

Suggested Citation

  • 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).
  • Handle: RePEc:uwp:jhriss:v:42:y:2007:i3:p682-700
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    References listed on IDEAS

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    1. Reinikka, Ritva & Svensson, Jakob, 2004. "Working for God?," CEPR Discussion Papers 4214, C.E.P.R. Discussion Papers.
    2. 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, vol. 53(2), pages 251-286, August.
    3. Tomas Philipson, 1996. "Private Vaccination and Public Health: An Empirical Examination for U.S. Measles," Journal of Human Resources, University of Wisconsin Press, vol. 31(3), pages 611-630.
    4. Edward Miguel & Michael Kremer, 2004. "Worms: Identifying Impacts on Education and Health in the Presence of Treatment Externalities," Econometrica, Econometric Society, vol. 72(1), pages 159-217, January.
    5. 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, vol. 22(1), pages 61-80, July.
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    Cited by:

    1. Das, Jishnu & Hammer, Jeffrey & Sánchez-Paramo, Carolina, 2012. "The impact of recall periods on reported morbidity and health seeking behavior," Journal of Development Economics, Elsevier, vol. 98(1), pages 76-88.
    2. Clemens, Michael A., 2009. "Skill Flow: A Fundamental Reconsideration of Skilled-Worker Mobility and Development," MPRA Paper 19186, University Library of Munich, Germany.
    3. 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.
    4. 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, vol. 48(C), pages 71-87.
    5. Serra, Danila & Serneels, Pieter & Barr, Abigail, 2010. "Intrinsic Motivations and the Non-Profit Health Sector: Evidence from Ethiopia," IZA Discussion Papers 4746, Institute of Labor Economics (IZA).
    6. 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, vol. 104(C), pages 56-63.
    7. Christophe Lemiére & Gaute Torsvik & Ottar Mæstad & Christopher H. Herbst & Kenneth L. Leonard, 2013. "Evaluating the Impact of Results-Based Financing on Health Worker Performance: Theory, Tools and Variables to Inform an Impact Evaluation," Health, Nutrition and Population (HNP) Discussion Paper Series 98269, The World Bank.
    8. Kimberly Singer Babiarz & Hongmei Yi & Renfu Luo, 2013. "Meeting the Health-care Needs of the Rural Elderly: The Unique Role of Village Doctors," China & World Economy, Institute of World Economics and Politics, Chinese Academy of Social Sciences, vol. 21(3), pages 44-60, May.
    9. repec:ebd:wpaper:165 is not listed on IDEAS
    10. Heather Klemick & Kenneth L. Leonard & Melkiory C. Masatu, 2007. "Defining Access to Health Care: Evidence on the Importance of Quality and Distance in Rural Tanzania," American Journal of Agricultural Economics, Agricultural and Applied Economics Association, vol. 91(2), pages 347-358.
    11. Brock, J. Michelle & Lange, Andreas & Leonard, Kenneth L., 2018. "Giving and promising gifts: Experimental evidence on reciprocity from the field," Journal of Health Economics, Elsevier, vol. 58(C), pages 188-201.
    12. J. Michelle Brock & Andreas Lange & Kenneth L. Leonard, 2016. "Generosity and Prosocial Behavior in Healthcare Provision: Evidence from the Laboratory and Field," Journal of Human Resources, University of Wisconsin Press, vol. 51(1), pages 133-162.
    13. Mbiti, Isaac M. & Serra, Danila, 2018. "Health Workers' Behavior, Patient Reporting and Reputational Concerns: Lab-in-the-Field Experimental Evidence from Kenya," IZA Discussion Papers 11352, Institute of Labor Economics (IZA).
    14. Jishnu Das, 2011. "The Quality of Medical Care in Low-Income Countries: From Providers to Markets," Working Papers id:3955, eSocialSciences.
    15. Leonard, Kenneth L. & Masatu, Melkiory C., 2010. "Using the Hawthorne effect to examine the gap between a doctor's best possible practice and actual performance," Journal of Development Economics, Elsevier, vol. 93(2), pages 226-234, November.
    16. Chandler, Clare I.R. & Chonya, Semkini & Mtei, Frank & Reyburn, Hugh & Whitty, Christopher J.M., 2009. "Motivation, money and respect: A mixed-method study of Tanzanian non-physician clinicians," Social Science & Medicine, Elsevier, vol. 68(11), pages 2078-2088, June.
    17. Leonard, Kenneth L. & Adelman, Sarah W. & Essam, Timothy, 2009. "Idle chatter or learning? Evidence of social learning about clinicians and the health system from rural Tanzania," Social Science & Medicine, Elsevier, vol. 69(2), pages 183-190, July.
    18. Mæstad, Ottar & Torsvik, Gaute, 2008. "Improving the quality of health care when health workers are in short supply," Working Papers in Economics 14/08, University of Bergen, Department of Economics.
    19. Ida Lindkvist, 2013. "Informal Payments And Health Worker Effort: A Quantitative Study From Tanzania," Health Economics, John Wiley & Sons, Ltd., vol. 22(10), pages 1250-1271, October.
    20. Leonard, Kenneth L., 2009. "The cost of imperfect agency in health care: Evidence from rural Cameroun," Journal of Development Economics, Elsevier, vol. 88(2), pages 282-291, March.
    21. Mæstad, Ottar & Torsvik, Gaute & Aakvik, Arild, 2010. "Overworked? On the relationship between workload and health worker performance," Journal of Health Economics, Elsevier, vol. 29(5), pages 686-698, September.
    22. repec:pri:rpdevs:hammer_the_impact_of_recall_periods_on_reported_morbidity_and_health_seek is not listed on IDEAS
    23. Kjell Hausken & Mthuli Ncube, 2014. "Political Economy of Service Delivery: Monitoring Versus Contestation," The Developing Economies, Institute of Developing Economies, vol. 52(1), pages 68-84, March.

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