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Which doctor? Combining vignettes and item response to measure doctor quality


  • Das, Jishnu
  • Hammer, Jeffrey


The authors develop a method in which vignettes-a battery of questions for hypothetical cases-are evaluated with item response theory to create a metric for doctor quality. The method allows a simultaneous estimation of quality and validation of the test instrument that can be used for further refinements. The authors apply the method to a sample of medical practitioners in Delhi, India. The method gives plausible results, rationalizes different perceptions of quality in the public and private sectors, and pinpoints several serious problems with health care delivery in urban India. The findings confirm, for instance, that the quality of private providers located in poorer areas of the city is significantly lower than those in richer neighborhoods. Surprisingly, similar results hold for providers in the public sector, with important implications for inequities in the availability of health care.

Suggested Citation

  • 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.
  • Handle: RePEc:wbk:wbrwps:3301

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    References listed on IDEAS

    1. R. Bock & Murray Aitkin, 1981. "Marginal maximum likelihood estimation of item parameters: Application of an EM algorithm," Psychometrika, Springer;The Psychometric Society, vol. 46(4), pages 443-459, December.
    2. 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.
    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. Foster, Andrew D, 1995. "Prices, Credit Markets and Child Growth in Low-Income Rural Areas," Economic Journal, Royal Economic Society, vol. 105(430), pages 551-570, May.
    5. 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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    Cited by:

    1. Xu, Guo, 2013. "Development through Empowerment: Delivering Effective Public Services – a Literature Review," ADB Economics Working Paper Series 382, Asian Development Bank.
    2. Susan Godlonton & Edward N. Okeke, 2015. "Does a Ban on Informal Health Providers Save Lives? Evidence from Malawi," Working Papers WR-1073-1, RAND Corporation.
    3. 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.
    4. Godlonton, Susan & Okeke, Edward N., 2016. "Does a ban on informal health providers save lives? Evidence from Malawi," Journal of Development Economics, Elsevier, vol. 118(C), pages 112-132.
    5. 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.
    6. World Bank, 2007. "India - Rural Governments and Service Delivery : Volume 3. Main Report," World Bank Other Operational Studies 8009, The World Bank.
    7. Leonard, Kenneth L. & Masatu, Melkiory C., 2005. "The use of direct clinician observation and vignettes for health services quality evaluation in developing countries," Social Science & Medicine, Elsevier, vol. 61(9), pages 1944-1951, November.
    8. 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.
    9. Kjell Hausken & Mthuli Ncube, 2013. "Working Paper 172 - Political Economy of Service Delivery: Monitoring versus Contestation," Working Paper Series 468, African Development Bank.
    10. Leonard, Kenneth L. & Masatu, Melkiory C., 2008. "Professionalism, Latent Professionalism and Organizational Demands for Health Care Quality in a Developing Country," Working Papers 42883, University of Maryland, Department of Agricultural and Resource Economics.
    11. Das, Jishnu & Hammer, Jeffrey, 2004. "Strained mercy : The quality of medical care in Delhi," Policy Research Working Paper Series 3228, The World Bank.
    12. World Bank, 2007. "India - Rural governments and Service Delivery : Volume 2. Note," World Bank Other Operational Studies 8008, The World Bank.
    13. Adelman, Sarah W. & Essam, Timothy M. & Leonard, Kenneth L., 2008. "Idle Chatter or Learning? Evidence from Rural Tanzania of Social Learning about Clinicians and the Health System," Working Papers 42884, University of Maryland, Department of Agricultural and Resource Economics.
    14. Bold, Tessa & Gauthier, Bernard & Svensson, Jakob & Wane, Waly, 2010. "Delivering service indicators in education and health in Africa : a proposal," Policy Research Working Paper Series 5327, The World Bank.
    15. Alderman, Harold & Das, Jishnu & Rao, Vijayendra, 2013. "Conducting ethical economic research: complications from the field," Policy Research Working Paper Series 6446, The World Bank.


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