Learning and Reputation with Asymmetric Information as Seen in Rural African Health Care

该项目调查了坦桑尼亚卫生部门中涉及质量多个方面的患者信息的作用，以及这些信息在质量变化时如何变化和更新。在坦桑尼亚，就像在大多数非洲国家一样，病人，即使是穷人，在寻求治疗时也有很多选择。虽然这可能涉及大量的额外费用，但患者经常绕过一个机构到另一个遥远的机构寻求治疗。质量的差异可以解释这一现象。然而，人们普遍认为，患者不能直接评价卫生保健质量的许多方面。病人知道某家医院更干净，工作人员更有礼貌，但他们不知道自己的咨询或处方的质量。他们寻求专业人士的服务，因为他们不知道专业人士所知道的，这使他们无法充分评估他们所得到的服务。该项目收集了一个独特的数据集，其中患者的选择与其他医生评估的质量的各个方面的客观测量相匹配。虽然病人不能直接评估所有方面的质量，但其他医生可以。数据描述了患者愿意为不同的客观质量方面承担额外的旅行费用。对前一轮数据收集的初步分析表明，患者了解质量的不可观察方面。额外的一轮数据定量地描述了患者了解他们无法直接观察到的事物的方法。数据描述了不同设施之间、在坦桑尼亚提供保健服务的不同组织之间、这些组织内部以及不同时期的质量差异。利用这些数据，该项目揭示了患者是否将声誉分配给组织、组织内的管理实践、个人设施，甚至个人医生。此外，它还描述了患者更新质量信息的速度。病人了解和更新质量信息的方式和速度对坦桑尼亚和整个非洲保健服务的权力下放、私有化和监管的未来具有重要影响。

This project investigates the role of patient information concerning multipleaspects of quality in the health sector of Tanzania, and how this informationchanges and is updated when quality changes. In Tanzania, as in most African countries, patients, even the poor, have anumber of choices when they seek care. Although it may involve significantadditional expense, patients frequently bypass one facility to seek care at amore distant facility. Differences in quality can explain this phenomenon.However, it is widely held that patients cannot directly evaluate many aspectsof quality in health care. Patients know that one facility is cleaner or has amore polite staff, but they do not know the quality of their consultation orprescription. They seek the services of a professional because they do not knowwhat professionals know, and this leaves them unable to fully evaluate theservices they receive.This project collects a unique data set in which patient choices are matchedwith objective measures of a variety of aspects of quality as evaluated byother physicians. Though patients cannot directly evaluate all aspects ofquality, another doctor can. The data depicts patients' willingness to incuradditional travel cost for different objective aspects of quality. Preliminary analysis of an earlier round of data collection has shown thatpatients know about unobservable aspects of quality. The additional round ofdata quantitatively characterizes the method by which patients learn aboutsomething that they cannot directly observe. The data depicts quality thatvaries between facilities, between the various organizations that providehealth services in Tanzania, within these organizations and over time. Usingthis data, the project reveals whether patients assign reputations toorganizations, management practices within organizations, individualfacilities, or even individual doctors. It addition, it depicts the speed withwhich patients update their information about quality. The manner and speed with which patients learn and update informationabout quality has important implications for the future of decentralization,privatization and regulation of health services in Tanzania and Africa ingeneral.