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Strained Mercy: The Quality of Medical Care in Delhi

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 characteristics, but little is known about how provider quality affects the provision of health care. We address this gap through a survey in Delhi with two related components. We 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 don’t do it in practice. This appears to be true in both the public and private sectors but for very different, and systematic, reasons. In the public sector providers are more likely to commit errors of omission—exert less effort compared to 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 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Policy Research Working Papers Unpaywall

Strained Mercy: The Quality of Medical Care in Delhi

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DOI
10.1596/1813-9450-3228
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Abstract

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. We address this gap through a survey in Delhi with two related components. We 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 don’t do it in practice. This appears to be true in both the public and private sectors but for very different, and systematic, reasons. In the public sector providers are more likely to commit errors of omission—exert less effort compared to 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

Published: Feb 25, 2004

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