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Rationing under Excess Demand: Evidence on Providers’ Adjustment Margins

Author

Listed:
  • Kovacs, Roxanne

    (Department of Economics, School of Business, Economics and Law, Göteborg University)

  • Abuya, Timothy
  • Powell-Jackson, Timothy

Abstract

Excess demand is pervasive in public service delivery, but its consequences depend on how providers allocate scarce capacity. We sent standardised patients – trained auditors posing as real patients – to 198 primary-care facilities in Nairobi. Across 1,326 pre-scheduled visits, we exploit within-facility variation in workload. We find that when queue length exceeds the typical daily workload per provider, waiting time is 21 minutes longer (0.4 SD). We find no reduction in consultation effort and no statistically significant deterioration in care quality or access. This suggests short-run congestion is borne primarily through users’ time and need not reduce service quality.

Suggested Citation

  • Kovacs, Roxanne & Abuya, Timothy & Powell-Jackson, Timothy, 2026. "Rationing under Excess Demand: Evidence on Providers’ Adjustment Margins," Working Papers in Economics 864, University of Gothenburg, Department of Economics.
    • Handle: RePEc:hhs:gunwpe:0864
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    File URL: https://hdl.handle.net/2077/93435
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    Keywords

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    JEL classification:

    • D24 - Microeconomics - - Production and Organizations - - - Production; Cost; Capital; Capital, Total Factor, and Multifactor Productivity; Capacity
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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