Two Indias: The structure of primary health care markets in rural Indian villages with implications for policy.
Two Indias: The structure of primary health care markets in rural Indian villages with implications for policy.
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DOI：
10.1016/j.socscimed.2020.112799
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发表时间：
2022-05
影响因子：
5.4
通讯作者：
Muralidharan, Karthik
中科院分区：
文献类型：
--
作者：
Das, Jishnu;Daniels, Benjamin;Ashok, Monisha;Shim, Eun-Young;Muralidharan, Karthik
2009年，我们访问了印度19个邦的1519个村庄，目的是(a)统计所有卫生保健提供者的数量，(b)通过医学知识测试得出他们的质量。我们记录了三个主要发现。首先，75%的村庄至少有一名卫生保健提供者，64%的护理是在拥有3名或更多提供者的村庄寻求的。大多数提供者在私营部门（86%），在私营部门，大多数是没有任何正式医疗培训的“非正式提供者”。我们的估计表明，这些非正式提供者占印度农村提供者总数的68%。其次，各州的教育质量差异很大，而正式资格证书并不能很好地预测教育质量。例如，泰米尔纳德邦和卡纳塔克邦非正规医务人员的医疗知识高于比哈尔邦和北方邦受过全面培训的医生。令人惊讶的是，非正规提供者的比例并没有随着社会经济地位的下降而下降。相反，他们的质量，以及私营和公共部门医生的质量，急剧提高。第三，印度不仅因医疗服务提供者的质量而分为两个国家，而且因成本而分为两个国家：表现较好的邦以较低的每次就诊成本提供更高的质量，这表明它们处于不同的生产可能性边界。这些模式与各州在医学教育的可获得性和质量方面的显著差异是一致的。我们的研究结果强调了医疗保健市场的复杂结构，私人非正式提供者的巨大份额，以及印度农村市场之间和内部医疗质量和成本的巨大差异。衡量和计算这种复杂性对印度的卫生保健政策至关重要。2010年，印度每个村庄平均有3.2个初级卫生保健提供者。其中，86%在私营部门工作，68%没有接受过正式的医疗培训。在较富裕的州，非正规提供者的比例并没有减少——质量得到了提高。在高绩效州，质量更高，每位患者的费用更低。卫生市场成本和质量的密度和变化具有政策意义。
We visited 1519 villages across 19 Indian states in 2009 to (a) count all health care providers and (b) elicit their quality as measured through tests of medical knowledge. We document three main findings. First, 75% of villages have at least one health care provider and 64% of care is sought in villages with 3 or more providers. Most providers are in the private sector (86%) and, within the private sector, the majority are ‘informal providers' without any formal medical training. Our estimates suggest that such informal providers account for 68% of the total provider population in rural India. Second, there is considerable variation in quality across states and formal qualifications are a poor predictor of quality. For instance, the medical knowledge of informal providers in Tamil Nadu and Karnataka is higher than that of fully trained doctors in Bihar and Uttar Pradesh. Surprisingly, the share of informal providers does not decline with socioeconomic status. Instead, their quality, along with the quality of doctors in the private and public sector, increases sharply. Third, India is divided into two nations not just by quality of health care providers, but also by costs: Better performing states provide higher quality at lower per-visit costs, suggesting that they are on a different production possibility frontier. These patterns are consistent with significant variation across states in the availability and quality of medical education. Our results highlight the complex structure of health care markets, the large share of private informal providers, and the substantial variation in the quality and cost of care across and within markets in rural India. Measuring and accounting for this complexity is essential for health care policy in India. In 2010, the average Indian village had 3.2 primary healthcare providers. Of these, 86% were in the private sector and 68% had no formal medical training. In richer states, the share of informal providers did not decrease—quality improved. In high-performing states, quality was higher and per-patient costs were lower. The density and variation of health market cost and quality has policy implications.
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影响因子：
9.7
作者：
Das, Jishnu;Hammer, Jeffrey
通讯作者：
Hammer, Jeffrey
影响因子：
9.7
作者：
Babiarz, Kimberly S.;Mahadevan, Swaminatha V.;Miller, Grant
通讯作者：
Miller, Grant
影响因子：
4.5
作者：
George G;Rhodes B
通讯作者：
Rhodes B
DOI：
10.1016/s1473-3099(15)00077-8
发表时间：
2015-11
期刊：
The Lancet. Infectious diseases
影响因子：
--
作者：
Das J;Kwan A;Daniels B;Satyanarayana S;Subbaraman R;Bergkvist S;Das RK;Das V;Pai M
通讯作者：
Pai M
影响因子：
10.7
作者：
Das, Jishnu;Holla, Alaka;Muralidharan, Karthik
通讯作者：
Muralidharan, Karthik