Strained Mercy: The Quality of Medical Care in Delhi
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 characterist...
| Main Authors: | , |
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| Format: | Policy Research Working Paper |
| Language: | English en_US |
| Published: |
World Bank, Washington, D.C.
2013
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| Subjects: | |
| Online Access: | http://documents.worldbank.org/curated/en/2004/03/3957282/strained-mercy-quality-medical-care-delhi http://hdl.handle.net/10986/14725 |
| Summary: | 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. |
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