Markets and Health Care Quality in Low and Middle-Income Countries
Sunday, Jan. 5, 2020 10:15 AM - 12:15 PM (PDT)
- Chair: Harsha Thirumurthy, University of Pennsylvania
Does the Market Reward Quality? Evidence from India
AbstractTwo salient facts about health care in LMICs are 1) the private sector plays an important role and 2) the care provided is often of poor quality. Despite these facts, we know little about what drives quality of care in the private sector and why patients seek care from poor quality providers. We use two field studies in India to examine this issue. First, we use a discrete choice experiment to show that patients are willing to pay higher prices for better technical quality. Second, we use standardized patients to show that private providers who provide better technical quality cannot charge higher prices. Our findings suggest that engaging patients with information on the technical quality of providers could shift demand to providers of better care.
The Baby Profit Gap: How childcare duties impact entrepreneurial performance
AbstractStudies have shown that women earn less than men as employees and also as business
owners. In Uganda, where 84% of all working women are self-employed, and most women are mothers, gender earnings disparities may lead to economic distortions and
lower economic mobility. In this paper, we estimate how much of the observed gender
profit gap can be explained by childcare duties. We collect original data from a representative sample of micro-entrepreneurs in select areas of Uganda, paired with data from real customers and confederate buyers (mystery shoppers). We document that 38% of female owners bring their small children to work, compared to 0% of men. To estimate the “baby profit gap”, we look within the sample of female owners to better account for other confounding factors between male and female owners. We find bringing a child to work is associated with 45% lower profits. The baby profit gap is consistently linked to stocking practices: mothers with children in the store are substantially more likely to run out of stock. We estimate that if all women earned profits equal to women without children at work, the median gender gap would fall by 50%.
Civil Service and Motivation in Publicly-Provided Health Care: An Audit Study of Physicians in China
AbstractPublic sector workers often under-perform relative to their abilities. One commonly-cited reason is that civil servants face incentives that are weak and misaligned with public objectives. We present causal estimates comparing the quality of care provided by civil service physicians with physicians hired on fixed-term contracts in rural China, where physicians of both types are commonly employed at the same facilities. We address endogeneity by using data from interactions with standardized patients and controlling for facility fixed effects. We find that physicians employed on fixed term contracts substantially outperform civil servants. These differences are due to effort, as civil service physicians under-perform relative to their knowledge. However, both civil service and fixed-term physicians are equally likely to prescribe unnecessary treatments.
- I1 - Health
- D4 - Market Structure, Pricing, and Design