Can Accreditation Improve Quality?: Experimental Evidence from U.S. Jails

Governments often rely on third-party oversight to assure service quality that is difficult to contract upon. We study accreditation of healthcare services in U.S. jails, where care is typically delivered by private contractors and overseen by elected sheriffs with limited medical expertise. In a multi-year randomized controlled trial across U.S. jails, we randomly offered subsidized accreditation from a third-party organization that sets quality standards, provides implementation guidance, and assesses compliance. The offer raises compliance with quality standards by approximately 10 percent, driven by improvement in standards for personnel training and patient care and treatment. We also find reductions in mortality that may reflect organizational changes extending beyond compliance with measured standards. In particular, accreditation improves coordination between custody and medical staff and strengthens managerial oversight by making healthcare practices more observable through documentation and facilitating information flows from staff to supervisors. Our findings suggest that accreditation can improve performance even where regulatory and financial incentives are weak.