Strained Mercy: The Quality ofMedical Care in Delhi

Das, Jishnu ; Hammer, Jeffrey S.

World Bank, Washington, D.C.

关键词: MEDICAL CARE FOR THE POOR;    MEDICINE;    ALTERNATIVE MEDICINE;    PUBLIC HEALTH;    HEALTH CARE;   

DOI  :  10.1596/1813-9450-3228
RP-ID  :  WPS3228

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

The quality of medical care is apotentially important determinant of health outcomes.Nevertheless, it remains an understudied area. The limitedresearch that exists defines quality either on the basis ofdrug availability or facility characteristics, but little isknown about how provider quality affects the provision ofhealth care. The authors address this gap through a surveyin Delhi with two related components. They evaluate"competence" (what providers know) throughvignettes and practice (what providers do) through directclinical observation. Overall quality as measured by thecompetence necessary to recognize and handle common anddangerous conditions is quite low, albeit with tremendousvariation. While there is some correlation with simpleobserved characteristics, there is still an enormous amountof variation within such categories. Further, even whenproviders know what to do they often do not do it inpractice. This appears to be true in both the public andprivate sectors though for very different, and systematic,reasons. In the public sector providers are more likely tocommit errors of omission-they are less likely to exerteffort compared with their private counterparts. In theprivate sector, providers are prone to errors ofcommission-they are more likely to behave according to thepatient's expectations, resulting in the inappropriateuse of medications, the overuse of antibiotics, andincreased expenditures. This has important policyimplications for our understanding of how market failuresand failures of regulation in the health sector affect the poor.