Watson Events

Jishnu Das -- Saving Meena - Quality of Care and Accountability in Health Markets

"Saving Meena - Quality of Care and Accountability in Health Markets," with Jishnu Das.  Das is a Senior Economist at The World Bank.

How do expanding service delivery markets, characterized by a dominant but lightly regulated private sector, providers with a wide range of medical training and, significant patient choice affect our understanding of health services in low-income countries?

Access to care in India is higher than in many OECD countries.  The average village in rural India now has 4 primary health care providers and including population clusters on nearby roads doubles that number. In urban India, the average household can access up to 70 providers within a 15-minute walk. Yet, we know little about the quality of care that patients receive when they enter clinics. Most providers are in the (virtually unregulated) private sector, and the majority in rural areas has no formal medical training. The private sector provides the bulk of primary care and accounts for up to 80 percent of first-contacts for primary care visits.

How do these markets function? What quality of care do medically untrained private providers dispense? What kinds of policies should governments pursue to improve health care in such environments?

Emerging research from India and other countries based on thousands of interviews with primary care providers, direct observations of doctor-patient interactions and household surveys sheds light on the functioning of service delivery markets. The research nuances the dominant perceptions of selfless behavior among doctors and the inability of households to assess and reward quality in such markets. By doing so, it opens up alternate paths to better accountability and delivery of health care—but also helps pinpoint the problems that such markets are currently unable to solve.

Location: McKinney Conference Room, Watson Institute, 111 Thayer Street