The World Bank Group, Washington, DC.
Department of Economics, University of Michigan, Ann Arbor, MI.
Am Econ Rev. 2016 Dec;106(12):3765-99. doi: 10.1257/aer.20151138.
We present unique audit-study evidence on health care quality in rural India, and find that most private providers lacked medical qualifications, but completed more checklist items than public providers and recommended correct treatments equally often. Among doctors with public and private practices, all quality metrics were higher in their private clinics. Market prices are positively correlated with checklist completion and correct treatment, but also with unnecessary treatments. However, public sector salaries are uncorrelated with quality. A simple model helps interpret our findings: Where public-sector effort is low, the benefits of higher diagnostic effort among private providers may outweigh costs of potential overtreatment.
我们提供了印度农村医疗质量的独特审计研究证据,发现大多数私人医疗机构缺乏医疗资质,但比公共医疗机构完成了更多的检查表项目,并且同样经常推荐正确的治疗方法。在有公私业务的医生中,所有的质量指标在私人诊所都更高。市场价格与检查表的完成和正确的治疗呈正相关,但也与不必要的治疗有关。然而,公共部门的工资与质量无关。一个简单的模型有助于解释我们的发现:在公共部门投入较低的情况下,私人医疗机构更高的诊断投入可能带来的好处超过潜在过度治疗的成本。