World Bank, Washington, D.C., USA.
Health Aff (Millwood). 2012 Dec;31(12):2774-84. doi: 10.1377/hlthaff.2011.1356.
This article reports on the quality of care delivered by private and public providers of primary health care services in rural and urban India. To measure quality, the study used standardized patients recruited from the local community and trained to present consistent cases of illness to providers. We found low overall levels of medical training among health care providers; in rural Madhya Pradesh, for example, 67 percent of health care providers who were sampled reported no medical qualifications at all. What's more, we found only small differences between trained and untrained doctors in such areas as adherence to clinical checklists. Correct diagnoses were rare, incorrect treatments were widely prescribed, and adherence to clinical checklists was higher in private than in public clinics. Our results suggest an urgent need to measure the quality of health care services systematically and to improve the quality of medical education and continuing education programs, among other policy changes.
本文报告了在印度农村和城市地区，私立和公立基层医疗服务提供者所提供的医疗服务质量。为了衡量医疗质量，研究使用了从当地社区招募并经过培训，以向提供者呈现一致病例的标准化患者。我们发现医疗服务提供者的医疗培训整体水平较低；例如，在农村的中央邦，接受抽样调查的医疗服务提供者中有 67%的人完全没有医学资格。更糟糕的是，我们发现，经过培训和未经培训的医生在遵守临床检查表等方面的差异很小。正确的诊断很少见，广泛开出错误的治疗方法，而且临床检查表的遵守情况在私人诊所比在公共诊所更高。我们的研究结果表明，迫切需要系统地衡量医疗服务质量，并改善医学教育和继续教育计划等政策的质量。
