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

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  • Das, Jishnu
  • Hammer, Jeffrey

Abstract

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.

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Paper provided by The World Bank in its series Policy Research Working Paper Series with number 3301.

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Date of creation: 01 May 2004
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Handle: RePEc:wbk:wbrwps:3301
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Keywords: Health Monitoring&Evaluation; Disease Control&Prevention; Health Systems Development&Reform; Public Health Promotion; Educational Sciences; Health Monitoring&Evaluation; Educational Sciences; Information and Records Management; Health Systems Development&Reform; Health Economics&Finance;

This paper has been announced in the following NEP Reports:

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  1. Paul Collier & Stefan Dercon & John Mackinnon, 2002. "Density versus quality in health care provision: Using household data to make budgetary choices in Ethiopia," CSAE Working Paper Series 2002-17, Centre for the Study of African Economies, University of Oxford.
  2. Jishnu Das & Stefan Dercon & James Habyarimana & Pramila Krishnan, 2004. "When Can School Inputs Improve Test Scores?," CSAE Working Paper Series 2004-25, Centre for the Study of African Economies, University of Oxford.
  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. 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.
  5. Foster, Andrew D, 1995. "Prices, Credit Markets and Child Growth in Low-Income Rural Areas," Economic Journal, Royal Economic Society, vol. 105(430), pages 551-70, May.
  6. R. Bock & Murray Aitkin, 1981. "Marginal maximum likelihood estimation of item parameters: Application of an EM algorithm," Psychometrika, Springer, vol. 46(4), pages 443-459, December.
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Cited by:

  1. 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.
  2. 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.
  3. Das, Jishnu & Hammer, Jeffrey, 2004. "Strained mercy : The quality of medical care in Delhi," Policy Research Working Paper Series 3228, The World Bank.
  4. 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.
  5. Kjell Hausken & Mthuli Ncube, 2013. "Working Paper 172 - Political Economy of Service Delivery: Monitoring versus Contestation," Working Paper Series 468, African Development Bank.
  6. Jishnu Das & Jeffrey Hammer & Carolina Sánchez-Paramo, 2011. "The Impact of Recall Periods on Reported Morbidity and Health Seeking Behavior," Working Papers 1320, Princeton University, Woodrow Wilson School of Public and International Affairs, Research Program in Development Studies..
  7. World Bank, 2007. "India - Rural Governments and Service Delivery : Volume 3. Main Report," World Bank Other Operational Studies 8009, The World Bank.
  8. Alderman, Harold & Das, Jishnu & Rao, Vijayendra, 2013. "Conducting ethical economic research: complications from the field," Policy Research Working Paper Series 6446, The World Bank.
  9. 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.
  10. 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.
  11. 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).
  12. World Bank, 2007. "India - Rural governments and Service Delivery : Volume 2. Note," World Bank Other Operational Studies 8008, The World Bank.
  13. Xu, Guo, 2013. "Development through Empowerment: Delivering Effective Public Services – a Literature Review," ADB Economics Working Paper Series 382, Asian Development Bank.

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