Variations in practice quality in five low-income countries: A conceptual overview

Health Affairs

Volumn 26, Issue 3, 2007, Pages

  Das, Jishnu ^a   Gertler, Paul J ^b,c  

^a WORLD BANK   (United States)

^b UNIVERSITY OF CALIFORNIA   (United States)

^c Graduate Program in Health Management

Author keywords

[No Author keywords available]

Indexed keywords

CLINICAL COMPETENCE; COMPARATIVE STUDY; DEVELOPING COUNTRY; HEALTH CARE DELIVERY; HEALTH CARE POLICY; HEALTH CARE QUALITY; HEALTH SERVICES RESEARCH; HUMAN; INDIA; INDONESIA; METHODOLOGY; MEXICO; ORGANIZATION AND MANAGEMENT; PARAGUAY; POVERTY; REVIEW; SOCIAL PSYCHOLOGY; TANZANIA;

CLINICAL COMPETENCE; DEVELOPING COUNTRIES; HEALTH POLICY; HEALTH SERVICES ACCESSIBILITY; HUMANS; INDIA; INDONESIA; MEXICO; ORGANIZATIONAL CASE STUDIES; PARAGUAY; POVERTY; PREJUDICE; PRIVATE SECTOR; PUBLIC SECTOR; QUALITY ASSURANCE, HEALTH CARE; QUALITY OF HEALTH CARE; TANZANIA;

EID: 34248504899     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.26.3.w296     Document Type: Review

References (18)

1. World Bank, Global Monitoring Report 2005, Millennium Development Goals: From Consensus to Momentum (Washington: World Bank, 2005).
2. M. Makinen et al., "Inequalities in Health Care Use and Expenditures: Empirical Data from Eight Developing Countries and Countries in Transition," Bulletin of the World Health Organization 78, no. 1 (2000): 55-65.
3. A.V. Banerjee, A. Deaton, and E. Duflo, "Wealth, Health, and Health Services in Rural Rajasthan," American Economic Review 94, no. 2 (2004): 326-330.
4. J. Das and C. Sánchez-Páramo, "Short but Not Sweet: New Evidence on Short Duration Morbidities from India," Policy Research Working Paper no. 2971 (Washington: World Bank, 2003).
5. Insurance claims and data on health outcomes are typically not available in low-income countries, and there is little evidence on the quality of the actual medical advice that patients receive. On the use of structural quality, see P. Collier, S. Dercon, and J. Mackinnon, "Density versus Quality in Health Care Provision: Using Household Data to Make Budgetary Choices in Ethiopia," World Bank Economic Review 16, no. 3 (2003): 425-448;
6. or V. Lavy and J. Germain, "Quality and Cost in Health Care Choice in Developing Countries," Living Standards Measurement Study Working Paper no. 105 (Washington: World Bank, 1994).
7. For a listing of the six papers discussed in this overview, see http://content.healthaffairs.org/cgi/content/full/26/3/w296/DC2.
8. Moreover, recurrent spending on medical supplies and infrastructure is small compared to spending on personnel. India spent more than 60 percent of its recurrent health budget (which accounts for 97 percent of all health spending) on salaries in 1990. See K.N. Reddy and V. Selvraju, "Health Care Expenditure by Government in India: 1974-75 to 1990-91" (New Delhi: National Institute of Public Finance and Policy, 1994).
9. One could still argue that infrastructure variables act as a "proxy" measure for the quality of medical advice. However, the country studies from Tanzania and Indonesia found little correlation between process and structural quality.
10. In Indonesia, the procedure differed in that the interviewer asked whether specific health services were provided in a given facility (including adult and child curative care and prenatal care). If so, the respondent identified a health care provider to answer questions about a case, evaluating procedures conducted during the provision of that service. Quality measures are therefore available only at the facility level, not the provider level.
11. The differences between vignettes and observation are also discussed in J. Das and J. Hammer, "Money for Nothing: The Dire Straits of Medical Practice in Delhi, India," Journal of Development Economics 83, no. 1 (2007): 1-36.
12. B.D. Smedley, A.Y. Stith, and A.R. Nelson, eds., Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (Washington: National Academies Press, 2002).
13. S.L. Barber, P.J. Gertler, and P. Harimurti, "The Contribution of Human Resources for Health to the Quality of Care in Indonesia," Health Affairs 26, no. 3 (2007): w367-w379 (published online 27 March 2007; 10.1377/hlthaff.26.3.w367).
14. Recent studies document absentee rates of public-sector doctors of up to 70 percent in rural Bangladesh; it is hard to argue that doctors need better training to know that they should show up forwork. See, for example, N.Chaudhury and J.S. Hammer, "Ghost Doctors: Absenteeism in Rural Bangaladeshi Health Facilities," World Bank Economic Review 18, no. 3 (2004): 423-441.
15. S. El Arifeen et al., "Integrated Management of Childhood Illness (IMCI) in Bangladesh: Early Findings from a Cluster-Randomised Study," Lancet 364, no. 9445 (2004): 1595-1602;
16. and J.R. Armstrong Schellenberg et al., "Effectiveness and Cost of Facility-Based Integrated Management of Childhood Illness (IMCI) in Tanzania," Lancet 364, no. 9445 (2004): 1583-1594.
17. See World Bank, World Development Report: Making Services Work for Poor People (Washington: World Bank, 2004).
18. S. Barber and P.G. Gertler, "Empowering Women: How Mexico's Oportunidades Improved Prenatal Care Quality and Birth Outcomes" (Washington: World Bank, 2006).