Quality and Accountability in Health Care Delivery: Audit-Study Evidence from Primary Care in India

Das, Jishnu; Holla, Alaka; Mohpal, Aakash; Muralidharan, Karthik

doi:10.1257/aer.20151138

Cited by 182 publications

(153 citation statements)

References 31 publications

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“…In this context, policies have to also focus on the dichotomy between rural-urban and public-private sector. While subsidized public healthcare in cities largely caters to the relatively better-off sections of the society, the rural healthcare system is either understaffed or manned by functionaries who are not equipped to give clinical care thus leading to high dependency on private providers with varying skills and competence [41,42]. In fact, better quality private healthcare services are iniquitous because they are profit-making (thus making them financially inaccessible) and urban centric [43].…”

Section: Discussionmentioning

confidence: 99%

Utilization of alternative systems of medicine as health care services in India: Evidence on AYUSH care from NSS 2014

et al. 2017

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AYUSH, an acronym for Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa and Homeopathy represents the alternative systems of medicine recognized by the Government of India. Understanding the patterns of utilization of AYUSH care has been important for various reasons including an increased focus on its mainstreaming and integration with biomedicine-based health care system. Based on a nationally representative health survey 2014, we present an analysis to understand utilization of AYUSH care across socioeconomic and demographic groups in India. Overall, 6.9% of all patients seeking outpatient care in the reference period of last two weeks have used AYUSH services without any significant differentials across rural and urban India. Importantly, public health facilities play a key role in provisioning of AYUSH care in rural areas with higher utilization in Chhattisgarh, Kerala and West Bengal. Use of AYUSH among middle-income households is lower when compared with poorer and richer households. We also find that low-income households display a greater tendency for AYUSH self-medication. AYUSH care utilization is higher among patients with chronic diseases and also for treating skin-related and musculo-skeletal ailments. Although the overall share of AYUSH prescription drugs in total medical expenditure is only about 6% but the average expenditure for drugs on AYUSH and allopathy did not differ hugely. The discussion compares our estimates and findings with other studies and also highlights major policy issues around mainstreaming of AYUSH care.

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Section: Discussionmentioning

confidence: 99%

Utilization of alternative systems of medicine as health care services in India: Evidence on AYUSH care from NSS 2014

et al. 2017

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“…A new set of studies highlights the role of healthcare quality, including dimensions such as provider effort ( e.g. Das and Hammer, ; Leonard, ; Leonard et al , ; Das et al , ; Leonard, ; Leonard and Masatu, ; Das et al , ) and provider absence ( e.g. Chaudhury et al , ; Das et al , ; Goldstein et al , ), in determining which health‐providers individuals use and health outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…First, I build on a recent body of economic literature from low‐ and middle‐income countries on healthcare quality ( e.g. Leonard et al , ; Mataria et al , ; Das and Hammer, ; Hanson et al , ; Chaudhury et al , ; Das and Gertler, ; Leonard, ; Leonard et al , ; Das et al , ; Leonard, ; Klemick et al , ; Leonard and Masatu, ; Fink et al , ; Goldstein et al , ; Corno, ; Das and Mohpal, ; Das et al , ; Hollard and Sene, ; Delavallade, ) and perceptions of healthcare quality and health ( e.g. Sen, ; Deaton, ; Deaton and Tortura, ) by providing some of the first large‐scale evidence on the relative roles of access and quality in determining healthcare use.…”

Section: Introductionmentioning

confidence: 99%

If You Build It Nearby and Keep the Price Low, Will They Come? Large‐Scale Evidence on the Relative Roles of Access and Quality in Use of Healthcare in Low‐and Middle‐Income Countries

Wilson

2020

South African J Economics

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Health policy reform often emphasises improving access to healthcare. Recent studies highlight the role healthcare quality plays in determining which health providers individuals use and health outcomes. Yet, there is little standardised large‐scale evidence on the importance of quality of care relative to access in determining healthcare use. This paper examines the relative roles of access and quality in whether individuals seek healthcare and how these vary with socioeconomic status in a sample of over 250,000 national household survey respondents from low‐ and middle‐income countries. My results suggest that quality is as large a barrier as access. Among quality barriers, drug availability is as large a barrier as provider availability. Analyses of the barriers‐socioeconomic status gradients indicate that the quality‐SES gradient is much less steep than the access‐SES gradient, highlighting that increasing incomes may not be sufficient to address quality barriers and that supply‐side interventions may be necessary.

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“…These poor health outcomes were partially due to the low quality of care in both public and private health sectors, including absenteeism, poor knowledge and the know–do gap, i.e. the gap between knowledge of appropriate care and the care actually delivered 3 – 12 …”

Section: Introductionmentioning

confidence: 99%

Evaluation of a social franchising and telemedicine programme and the care provided for childhood diarrhoea and pneumonia, Bihar, India

Mohanan

Giardili

Das

et al. 2017

Bull. World Health Organ.

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ObjectiveTo evaluate the impact on the quality of the care provided for childhood diarrhoea and pneumonia in Bihar, India, of a large-scale, social franchising and telemedicine programme – the World Health Partners’ Sky Program.MethodsWe investigated changes associated with the programme in the knowledge and performance of health-care providers by carrying out 810 assessments in a representative sample of providers in areas where the programme was and was not implemented. Providers were assessed using hypothetical patient vignettes and the standardized patient method both before and after programme implementation, in 2011 and 2014, respectively. Differences in providers’ performance between implementation and nonimplementation areas were assessed using multivariate difference-in-difference linear regression models.FindingsThe programme did not significantly improve health-care providers’ knowledge or performance with regard to childhood diarrhoea or pneumonia in Bihar. There was a persistent large gap between knowledge of appropriate care and the care actually delivered.ConclusionSocial franchising has received attention globally as a model for delivering high-quality care in rural areas in the developing world but supporting data are scarce. Our findings emphasize the need for sound empirical evidence before social franchising programmes are scaled up.

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Quality and Accountability in Health Care Delivery: Audit-Study Evidence from Primary Care in India

Cited by 182 publications

References 31 publications

Utilization of alternative systems of medicine as health care services in India: Evidence on AYUSH care from NSS 2014

Utilization of alternative systems of medicine as health care services in India: Evidence on AYUSH care from NSS 2014

If You Build It Nearby and Keep the Price Low, Will They Come? Large‐Scale Evidence on the Relative Roles of Access and Quality in Use of Healthcare in Low‐and Middle‐Income Countries

Evaluation of a social franchising and telemedicine programme and the care provided for childhood diarrhoea and pneumonia, Bihar, India

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