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  • 1
    Language: English
    Pages: 1 Online-Ressource (65 pages)
    Parallel Title: Erscheint auch als Bedoya, Guadalupe Randomized Regulation: The Impact of Minimum Quality Standards on Health Markets
    Keywords: Gesundheitswesen ; Gesundheitsreform ; Patienten ; Gesundheitsversorgung ; Produktqualität ; Epidemie ; Regulierung ; Experiment ; Kenia ; Health Care Market ; Health Care Utilizaton ; Health, Nutrition and Population ; Informal Sector ; Patient Safety Standards ; Public Health ; Regulatory Enforcement
    Abstract: This paper presents results from the first randomization of a regulatory reform in the health sector. The reform established minimum quality standards for patient safety, an issue that has become increasingly salient following the Ebola and COVID-19 epidemics. In the experiment, all 1,348 health facilities in three Kenyan counties were classified into 273 markets, and the markets were then randomly allocated to treatment and control groups. Government inspectors visited health facilities and, depending on the results of their inspection, recommended closure or a timeline for improvements. The intervention increased compliance with patient safety measures in both public and private facilities (more so in the latter) and reallocated patients from private to public facilities without increasing out-of-pocket payments or decreasing facility use. In treated markets, improvements were equally marked throughout the quality distribution, consistent with a simple model of vertical differentiation in oligopolies. This paper thus establishes the use of experimental techniques to study regulatory reforms and, in doing so, shows that minimum standards can improve quality across the board without adversely affecting utilization
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  • 2
    Language: English
    Pages: 1 Online-Ressource (58 pages)
    Parallel Title: Erscheint auch als Das, Jishnu The Prices in the Crises: What we are Learning from Twenty Years of Health Insurance in Low- and Middle-Income Countries
    Keywords: Gesundheitspolitik ; Krankenversicherung ; Gesetzliche Krankenversicherung ; Gesundheitsreform ; Gesundheitswesen ; Gesundheitsversorgung ; Gesundheitskosten ; Gesundheitsfinanzierung ; Adverse Selektion ; Entwicklungsländer ; Adverse Selection ; Health Care Provider Behavior ; Health Care Quality ; Health Insurance ; Health Insurance Utilization ; Health Ministries ; Health Policy and Management ; Health, Nutrition and Population ; Medical Insurance Premiums ; Moral Hazard
    Abstract: Governments in many low- and middle-income countries are developing health insurance products as a complement to tax-funded, subsidized provision of health care through publicly operated facilities. This paper discusses two rationales for this transition. First, health insurance would boost fiscal revenues for health care, as post-treatment out-of-pocket payments to providers would be replaced by pre-treatment insurance premia to health ministries. Second, increased patient choice and carefully designed physician reimbursements would increase quality in the health care sector. This essay shows that, at best, these objectives have only been partially met. Despite evidence that health insurance has provided financial protection, consumers are not willing to pay for unsubsidized premia. Health outcomes have not improved despite an increase in utilization. The authors argue that this is not because there was no room to improve the quality of care but because behavioral responses among health care providers have systematically undermined the objectives of these insurance schemes
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  • 3
    Language: English
    Pages: Online-Ressource (1 online resource (29 p.))
    Edition: Online-Ausg. World Bank E-Library Archive
    Parallel Title: Das, Jishnu Mental Health Patterns And Consequences
    Keywords: Anxiety ; Depression ; Health Monitoring and Evaluation ; Health care ; Health indicators ; Health outcomes ; Health, Nutrition and Population ; Mental ; Mental Health ; Mental illness ; Morbidity ; Public health ; Anxiety ; Depression ; Health Monitoring and Evaluation ; Health care ; Health indicators ; Health outcomes ; Health, Nutrition and Population ; Mental ; Mental Health ; Mental illness ; Morbidity ; Public health ; Anxiety ; Depression ; Health Monitoring and Evaluation ; Health care ; Health indicators ; Health outcomes ; Health, Nutrition and Population ; Mental ; Mental Health ; Mental illness ; Morbidity ; Public health
    Abstract: The social and economic consequences of poor mental health in the developing world are presumed to be significant, yet are largely under-researched. The authors argue that mental health modules can be meaningfully added to multi-purpose household surveys in developing countries, and used to investigate this relationship. Data from nationally representative surveys in Bosnia and Herzegovina, Indonesia, and Mexico, along with special surveys from India and Tonga, show similar patterns of association between mental health and socioeconomic characteristics across countries. Individuals who are older, female, widowed, and report poor physical health are more likely to report worse mental health outcomes. Individuals living with others with poor mental health are also significantly more likely to report worse mental health themselves. In contrast, there is little observed relationship between mental health and poverty or education, common measures of socio-economic status. The results instead suggest that economic and multi-dimensional shocks such as illness or crisis can have a greater impact on mental health than overall levels of poverty. This may have important implications for social protection policy. The authors also find significant associations between poor mental health and lowered labor force participation (especially for women) and higher frequency visits to health centers, suggesting that poor mental health can have significant economic consequences for households and the health system. Finally, the paper discusses how measures of mental health are distinct from general subjective welfare measures such as happiness and indicate useful directions of future research
    URL: Volltext  (Deutschlandweit zugänglich)
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  • 4
    Language: English
    Pages: Online-Ressource (1 online resource (38 p.))
    Edition: Online-Ausg. World Bank E-Library Archive
    Parallel Title: Das, Jishnu The Quality of Medical Advice In Low-Income Countries
    Keywords: Clinics ; Health Monitoring and Evaluation ; Health Systems Development and Reform ; Health outcomes ; Health, Nutrition and Population ; Intervention ; Medicines ; Nutrition ; Patient ; Patients ; Primary Health Care ; Vaccination ; Workers ; Clinics ; Health Monitoring and Evaluation ; Health Systems Development and Reform ; Health outcomes ; Health, Nutrition and Population ; Intervention ; Medicines ; Nutrition ; Patient ; Patients ; Primary Health Care ; Vaccination ; Workers ; Clinics ; Health Monitoring and Evaluation ; Health Systems Development and Reform ; Health outcomes ; Health, Nutrition and Population ; Intervention ; Medicines ; Nutrition ; Patient ; Patients ; Primary Health Care ; Vaccination ; Workers
    Abstract: This paper provides an overview of recent work on quality measurement of medical care and its correlates in four low and middle-income countries-India, Indonesia, Tanzania, and Paraguay. The authors describe two methods-testing doctors and watching doctors-that are relatively easy to implement and yield important insights about the nature of medical care in these countries. The paper discusses the properties of these measures, their correlates, and how they may be used to evaluate policy changes. Finally, the authors outline an agenda for further research and measurement
    URL: Volltext  (Deutschlandweit zugänglich)
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  • 5
    Language: English
    Pages: Online-Ressource (1 online resource (20 p.))
    Edition: Online-Ausg. World Bank E-Library Archive
    Parallel Title: Das, Jishnu Patient Satisfaction, Doctor Effort, And Interview Location
    Keywords: Aged ; Clinics ; Gender ; Gender and Health ; General Practice ; Health ; Health Care ; Health Monitoring and Evaluation ; Health Outcomes ; Health Services ; Health Systems Development and Reform ; Health, Nutrition and Population ; Hospitals ; Interview ; Knowledge ; Measurement ; Medicines ; Nursing ; Observation ; Aged ; Clinics ; Gender ; Gender and Health ; General Practice ; Health ; Health Care ; Health Monitoring and Evaluation ; Health Outcomes ; Health Services ; Health Systems Development and Reform ; Health, Nutrition and Population ; Hospitals ; Interview ; Knowledge ; Measurement ; Medicines ; Nursing ; Observation ; Aged ; Clinics ; Gender ; Gender and Health ; General Practice ; Health ; Health Care ; Health Monitoring and Evaluation ; Health Outcomes ; Health Services ; Health Systems Development and Reform ; Health, Nutrition and Population ; Hospitals ; Interview ; Knowledge ; Measurement ; Medicines ; Nursing ; Observation
    Abstract: To examine the relationship between patient satisfaction and doctor performance, the authors observed 2,271 interactions between 292 doctors and their patients in 98 clinics and hospitals in Paraguay and conducted an exit-survey with the same patients as they left the clinic. For a subsample of 64 facilities they also interviewed patients who visited the facility within the last week. There are three patterns in the data: (1) Patient satisfaction is positively correlated with doctor effort, measured as a combination of time spent, questions asked, and examinations performed after controlling for observed doctor and patient characteristics; (2) However, accounting for unobserved doctor characteristics dramatically reduces the level of significance and size of correlation between effort and satisfaction, showing that much of the positive relationship is driven by these unobserved doctor-specific factors; and (3) Reported satisfaction is significantly lower for patients interviewed at home compared with those interviewed at the clinic. This leads the authors to conclude that even if patient satisfaction reflects some aspects of the doctor's performance, unobserved heterogeneity combined with survey biases limit the widespread applicability of patient satisfaction as an indicator of doctor performance
    URL: Volltext  (Deutschlandweit zugänglich)
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