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Strained mercy : The quality of medical care in Delhi

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  • Das, Jishnu
  • Hammer, Jeffrey

Abstract

The quality of medical care is a potentially important determinant of health outcomes. Nevertheless, it remains an understudied area. The limited research that exists defines quality either on the basis of drug availability or facility characteristics, but little is known about how provider quality affects the provision of health care. The authors address this gap through a survey in Delhi with two related components. They evaluate"competence"(what providers know) through vignettes and practice (what providers do) through direct clinical observation. Overall quality as measured by the competence necessary to recognize and handle common and dangerous conditions is quite low, albeit with tremendous variation. While there is some correlation with simple observed characteristics, there is still an enormous amount of variation within such categories. Further, even when providers know what to do they often do not do it in practice. This appears to be true in both the public and private sectors though for very different, and systematic, reasons. In the public sector providers are more likely to commit errors of omission-they are less likely to exert effort compared with their private counterparts. In the private sector, providers are prone to errors of commission-they are more likely to behave according to the patient's expectations, resulting in the inappropriate use of medications, the overuse of antibiotics, and increased expenditures. This has important policy implications for our understanding of how market failures and failures of regulation in the health sector affect the poor.

Suggested Citation

  • Das, Jishnu & Hammer, Jeffrey, 2004. "Strained mercy : The quality of medical care in Delhi," Policy Research Working Paper Series 3228, The World Bank.
  • Handle: RePEc:wbk:wbrwps:3228
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    File URL: http://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2004/06/04/000009486_20040604115601/Rendered/PDF/wps3228Delhi.pdf
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    References listed on IDEAS

    as
    1. Paul Collier & Stefan Dercon & John Mackinnon, 2002. "Density versus Quality in Health Care Provision: Using Household Data to Make Budgetary Choices in Ethiopia," World Bank Economic Review, World Bank Group, vol. 16(3), pages 425-448, December.
    2. Das, Jishnu & Hammer, Jeffrey, 2007. "Money for nothing: The dire straits of medical practice in Delhi, India," Journal of Development Economics, Elsevier, vol. 83(1), pages 1-36, May.
    3. Leonard, Kenneth L., 2003. "African traditional healers and outcome-contingent contracts in health care," Journal of Development Economics, Elsevier, vol. 71(1), pages 1-22, June.
    4. 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.
    5. Kamat, Vinay R. & Nichter, Mark, 1998. "Pharmacies, self-medication and pharmaceutical marketing in Bombay, India," Social Science & Medicine, Elsevier, vol. 47(6), pages 779-794, September.
    6. 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.
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    Citations

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    Cited by:

    1. David Cutler & Angus Deaton & Adriana Lleras-Muney, 2006. "The Determinants of Mortality," Journal of Economic Perspectives, American Economic Association, vol. 20(3), pages 97-120, Summer.
    2. Grant Miller & Kimberly Singer Babiarz, 2013. "Pay-for-Performance Incentives in Low- and Middle-Income Country Health Programs," NBER Working Papers 18932, National Bureau of Economic Research, Inc.
    3. Das, Jishnu & Hammer, Jeffrey, 2007. "Money for nothing: The dire straits of medical practice in Delhi, India," Journal of Development Economics, Elsevier, vol. 83(1), pages 1-36, May.
    4. Abhijit V. Banerjee & Esther Duflo, 2007. "The Economic Lives of the Poor," Journal of Economic Perspectives, American Economic Association, vol. 21(1), pages 141-168, Winter.
    5. Sheikh, Kabir & Porter, John, 2010. "Discursive gaps in the implementation of public health policy guidelines in India: The case of HIV testing," Social Science & Medicine, Elsevier, vol. 71(11), pages 2005-2013, December.
    6. Luke, Nancy & Munshi, Kaivan, 2007. "Social affiliation and the demand for health services: Caste and child health in South India," Journal of Development Economics, Elsevier, vol. 83(2), pages 256-279, July.
    7. Renfu Luo & Grant Miller & Scott Rozelle & Sean Sylvia & Marcos Vera-Hernández, 2015. "Can Bureaucrats Really Be Paid Like CEOs? School Administrator Incentives for Anemia Reduction in Rural China," NBER Working Papers 21302, National Bureau of Economic Research, Inc.
    8. Aniket, Kumar, 2018. "Solow-Swan growth model with global capital markets and congestible public goods," MPRA Paper 87844, University Library of Munich, Germany.

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