The government has pumped and pumped money into the healthcare market—the expenditure for rural healthcare, for instance, has risen to Rs 30,400 crore in 2011-12 from R10,000 crore in 2004-05—yet providing quality care to most, the kind that most readers of this newspaper would presumably receive, still seems an elusive goal. Often enough, the roots of this defect are presumed to range from the low quality of infrastructure—doctors not having the right instruments, dirty hospitals, overcrowdedness, etc. However, a new study, by World Bank economists, points the finger in an unlikely direction—the health-providers. Twenty-two selected people were made to visit at least 926 times a sample of 305 healthcare-providers (both private and public) in rural Madhya Pradesh and urban Delhi, in order to judge the quality of diagnosis provided by the health-providers. Their ailments were standardised into three variegated illnesses—asthma, child-with-dysentery and unstable angina.
The results have been disappointing. As it happens, the majority of those providing healthcare are not trained professionally—close to 70% in rural MP had no medical qualification, whereas only a third could articulate a diagnosis (of which only half were partially or wholly correct). In urban Delhi, the results were more encouraging; 52% of Delhi health-providers could boast of a medical degree, whereas 21% of the providers provided a proper diagnosis. But there is an interesting caveat in the report, which may be the key to further quality-enhancement—the vibrancy of the private-healthcare providers. Although private players in rural MP, on an average, had less formal training than public-sector healthcare providers, their adherence to a required checklist was substantially higher (6.81% more than public-sector providers). Similarly, private health-providers in urban Delhi trumped public-sector workers, albeit with a smaller margin (reflecting the better quality of public health institutions in Delhi). In the report’s own words, “Evidence suggests that private-sector providers were better in adhering to the checklist … than their public-sector counterparts”. Why? Because “provider effort” becomes the “key determinant of quality”. And those whose incomes directly relate to their work would obviously put in more effort.