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Medical Quality and Incentives

Kenneth Leonard, Agriculture and Resource Economics

The seed grant provieds support for research and proposal development on the ability and quality of care provided by medical practitioners in Tanzania. Using data from rural Tanzania, Leonard, Masatu and Vialou (2004) show that doctors who work for organizations that use high-powered incentives provide higher quality care, even after controlling for ability. This has important implications for medical care in Tanzania, Africa and developing countries, suggesting that institutional reform can increase quality without additional training or resources. Work on the current data suggest two potential pitfalls of our sample: first they do not have any private doctors in our sample and therefore cannot observe the behavior of clinicians who face the highest possible incentives. Second, reviewers of the investigators previous papers have expressed concerns that one of our measures of quality --- the degree to which observed quality declines with the time we have been observing the clinician --- may be measuring something that is not driven by quality at all. Each of these issues is easily remedied and we therefore propose to collect additional data by visiting all 12 private practitioners in our sample area and by observing five clinicians over a three day period to determine if the pattern of quality decline is a function of our presence rather than a function of the normal cycle of the day. This proposal will allow the author to explore the possibilities for an NICHD R01 or R03 proposal based on this data set.

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