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Quality of Health Care in India

Jeffrey Hammer has been developing methods of measuring the quality of health care in developing countries.

Defining "quality" of health care in economic research has always been problematic.  For a long time it was identified with "presence of drugs or equipment" which has little to do with the quality in terms of accuracy and effectiveness of advice given at a clinic.  This project was originated to make progress on this score using a variety of techniques using data collected on over 200 medical providers in Delhi chosen from a census of providers in areas of Delhi with an ongoing household survey.  The providers were both public and private and within the private, spanned the range from highly trained doctors to people with no training at all.

The first technique was the use of "vignettes" or hypothetical cases presented to doctors by two interviewers, one playing the role of patient and the other a recorder (and course of answers to possible test results if called for by the medical provider).  The second technique was simply to have an interviewer sit with a provider for the day, recording all visits (time spent, number of relevant questions asked, money paid, whether a diagnosis was given, medicines prescribed, etc.).  This allowed for a variety of tests of quality of advice and the difference between what doctors say they would do and what they actually do.  It also highlighted the deficiencies that poor people face in both public and private sectors.

Methods using Standardized Simulated Patients have been developed and variants on all methods are being adapted and used by a variety of researchers (See Health Affairs, v. 26, no. 3, March 2007 Special issue; Dehn, Reinikka and Svensson at World Bank website).

This project is being done in conjunction with Jishnu Das at the World Bank and the Institute of Socio-Economic Research on Development and Democracy, Delhi.