Does the quality of healthcare providers that people use vary systematically by socio-economic status (SES) in rural India? A new study published Thursday in the special issue of the Health Affairs Journal said the quality of health care depends mainly on where people live than who they are.
Researchers Jishnu Das and Aakash Mohpal, economists with the World Bank, Washington, surveyed more than 23,000 households in 100 villages of Madhya Pradesh and collected data between 2009 and 2011 on the quality of health care providers and primary care visits.”We were able to study for the first time the key question of whether households that have low socio economic status in rural India receive lower quality care and if so by how much,” Das, who is also a senior visiting fellow at the Centre for Policy Research, New Delhi told The Indian Express.
The findings of the study ‘Socioeconomic Status and Quality of Care in Rural India: New Evidence from Provider and Household’ show that where people live matters more than who they are. Striking evidence in this study population — the majority of which is poor and illiterate — shows that households can assess the quality of health care providers and actively seek out higher quality. When patients travel farther, they access higher quality care. Low socio-economic status households tend to travel farther than high socio-economic status ones to access the same quality care, the study found.
The study funded by the Global Health Program of the Bill and Melinda Gates Foundation was conducted with the Center for Policy Research, New Delhi and the Institute for Socioeconomic Research on Democracy and Development in Delhi. “The average village in our sample could access 11 healthcare providers and 49 percent of these providers had no formal medical training. Usage data are even more striking: 77 percent of all primary care visits were to providers without any formal medical training. Only 11 percent of all primary care visits were to the public sector and only 4 percent were to providers with an MBBS degree. Providers of average quality in our sample were able to correctly diagnose five key conditions 47.3% of the time and correctly treat these conditions 68% of the time. Because in some cases correct treatment could include “referrals to a higher level”, conditions could be correctly treated without a correct diagnosis,” Das said.
Providers with an MBBS degree had higher correct diagnosis and correct treatment rates, relative to those with alternate qualifications (AYUSH) and those without any medical training. When it comes to equity, there is a key difference between the ‘village’ and the ‘household’ as the unit of analysis. Low SES households living in low SES villages use low quality care. But low SES households living in high SES villages use higher quality care. In fact, if we compare low and high SES households living in the same village, we find no difference in the quality of care they receive, researchers have said.