Location, location, location: Residence, wealth, and the quality of medical care in Delhi, India

Health Affairs

Volumn 26, Issue 3, 2007, Pages

  Das, Jishnu ^a   Hammer, Jeffrey ^a  

^a WORLD BANK   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CLINICAL COMPETENCE; DEMOGRAPHY; EPIDEMIOLOGY; HEALTH CARE DELIVERY; HEALTH CARE QUALITY; HUMAN; INCOME; INDIA; MULTIVARIATE ANALYSIS; REGRESSION ANALYSIS; STATISTICS;

CLINICAL COMPETENCE; HEALTH CARE SURVEYS; HEALTH SERVICES ACCESSIBILITY; HUMANS; INCOME; INDIA; MULTIVARIATE ANALYSIS; QUALITY OF HEALTH CARE; REGRESSION ANALYSIS; RESIDENCE CHARACTERISTICS;

EID: 34248536541     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.26.3.w338     Document Type: Article

References (23)

1. World Bank, World Development Report: Investing in Health (Washington: World Bank, 1993).
2. National Sample Survey, Registration System Bulletin 32, no. 2 (Delhi: National Sample Survey, 2001);
3. and A. Shariff, India Human Development Report (Delhi: National Council of Applied Economic Research and Oxford University Press, 1999).
4. World Health Organization, The Alma-Ata Declaration (Geneva:WHO, 1980), 3.
5. 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).
6. Authors' calculations based on data from the National Family Health Survey (1999) for Delhi. Among households in the richest decile, there were no reported infant deaths in the NFHS (1999). The infant mortality rate for the poor is just above the national rate of 68 per 1,000 births.
7. J. Das and P.J. Gertler, "Variations in Practice Quality in Five Low-Income Countries: A Conceptual Overview," Health Affairs 26, no. 3 (2007): w296-w309 (published online 27 March 2007; 10.1377/hlthaff.26.3.w296) .
8. Training for providers (other than those with an MB BS degree) draws on different traditions in Indian medicine and includes bachelor of Ayurvedic medicine and surgery (BAMS), bachelor of integrated medicine and surgery (BIMS), and bachelor of Unani medicine and surgery (BUMS). Further down the order are the registered medical practitioners (RMPs) or paramedics with some rudimentary training; given the limited regulatory powers of government authorities, there are also providers with no formal training.
9. A. Mahal et al., "The Poor and Health Service Use in India" (Washington: World Bank, 2001).
10. WHO, The World Health Report 2000 - Health Systems: Improving Performance (Geneva: WHO, 2000).
11. The use of vignettes as a measure of quality has increased in the United States during the past decade. See J.W. Peabody et al., "Comparison of Vignettes, Standardized Patients, and Chart Abstraction: A Prospective Validation Study of Three Methods for Measuring Quality," Journal of the American Medical Association 283, no. 13 (2000): 1715-1722.
12. A technical scoring algorithm and discussion of the vignettes is presented in J. Das and J. Hammer, "Which Doctor: Combining Vignettes and Item Response to Measure Provider Competence," Journal of Development Economics 78, no. 2 (2005): 348-383.
13. The sample is discussed in Das and Sánchez-Páramo, "Short but Not Sweet."
14. The first set was drawn via probability proportional to visits (size), and the second was drawn randomly with equal weights (the scheme for the first set explains the variation across localities - some neighborhoods had fewer total providers visited during the survey period).
15. A table describing these findings is available in an online technical appendix, at http://content.health affairs.org/cgi/content/full/26/3/w338/DC2.
16. Das and Hammer, "Which Doctor," uses a different scoring technique derived from Item Response Theory with somewhat different results than presented here. For comparability with other country studies from Indonesia and Tanzania in this collection of Health Affairs papers, we used the standardized raw score formulation.
17. A graphic describing these findings is available in an online technical appendix, as in Note 13.
18. J. Das and J. Hammer, "Money for Nothing: The Dire Straits of Medical Practice in India," Journal of Development Economics 83, no. 1 (2007): 1-36.
19. Similar results are reported for the Netherlands by J.J. Rethans et al., "Does Competence of General Practitioners Predict Their Performance? Comparison between Examination Setting and Actual Practice," British Medical Journal 303, no. 6814 (1991): 1377-1380;
20. and for Tanzania by K.L. Leonard and M.C. Masatu, "Comparing Vignettes and Direct Clinical Observation in a Developing Country Context" (Unpublished paper, University of Maryland, 2003).
21. Das and Hammer, "Money for Nothing."
22. Ibid.
23. J. Jalan and E. Somanathan, "Being Informed Matters: Experimental Evidence on the Demand for Environmental Quality," ISI Discussion Paper no. 04-08 (New Delhi: Indian Statistical Institute, 2004).