Department of Economics, Sociology and Statistics, RAND Corporation, Santa Monica, CA, USA.
Pardee RAND Graduate School, Santa Monica, CA, USA.
Science. 2024 Feb 9;383(6683):eadj9986. doi: 10.1126/science.adj9986.
Most health care providers in developing countries know that oral rehydration salts (ORS) are a lifesaving and inexpensive treatment for child diarrhea, yet few prescribe it. This know-do gap has puzzled experts for decades. Using randomized experiments in India, we estimated the extent to which ORS underprescription is driven by perceptions that patients do not want ORS, provider's financial incentives, and ORS stock-outs (out-of-stock events). Patients expressing a preference for ORS increased ORS prescribing by 27 percentage points. Eliminating stock-outs increased ORS provision by 7 percentage points. Removing financial incentives did not affect ORS prescribing on average but did increase ORS prescribing at pharmacies. We estimate that perceptions that patients do not want ORS explain 42% of underprescribing, whereas stock-outs and financial incentives explain only 6 and 5%, respectively.
发展中国家的大多数医疗服务提供者都知道口服补液盐（ORS）是一种挽救生命且廉价的儿童腹泻治疗方法，但很少有人开这种药。数十年来，这种理论与实践之间的差距一直困扰着专家。我们在印度进行了随机对照试验，以评估开处方时不使用 ORS 的情况在多大程度上是由于患者表示不想要 ORS、提供者的经济激励以及 ORS 缺货（缺货事件）造成的。患者表示更倾向于使用 ORS 时，开处方使用 ORS 的比例增加了 27 个百分点。消除缺货现象使 ORS 的供应增加了 7 个百分点。取消经济激励措施平均而言并不会影响 ORS 的开方，但确实会增加药店的 ORS 开方。我们估计，患者表示不想要 ORS 的看法解释了 42%的开方不足，而缺货和经济激励的解释分别仅为 6%和 5%。
