Chr Michelsen Institute, Bergen, Norway.
J Health Econ. 2010 Sep;29(5):686-98. doi: 10.1016/j.jhealeco.2010.05.006. Epub 2010 Jun 1.
The shortage of health workers in many low-income countries poses a threat to the quality of health services. When the number of patients per health worker grows sufficiently high, there will be insufficient time to diagnose and treat all patients adequately. This paper tests the hypothesis that high caseload reduces the level of effort per patient in the diagnostic process. We observed 159 clinicians in 2095 outpatient consultations at 126 health facilities in rural Tanzania. Surprisingly, we find no association between caseload and the level of effort per patient. Clinicians appear to have ample amounts of idle time. We conclude that health workers are not overworked and that scaling up the number of health workers is unlikely to raise the quality of health services. Training has a positive effect on quality but is not in itself sufficient to raise quality to adequate levels.
许多低收入国家的卫生工作者短缺对卫生服务的质量构成威胁。当每个卫生工作者的患者人数增加到足够多时，就没有足够的时间来充分诊断和治疗所有患者。本文检验了一个假设，即高病例量会降低诊断过程中每个患者的努力程度。我们观察了坦桑尼亚农村 126 家卫生机构的 159 名临床医生在 2095 次门诊就诊中的情况。令人惊讶的是，我们没有发现病例量与每个患者的努力程度之间存在关联。临床医生似乎有大量的空闲时间。我们的结论是，卫生工作者并没有过度劳累，增加卫生工作者的数量不太可能提高卫生服务的质量。培训对质量有积极影响，但本身不足以将质量提高到足够水平。
