Management Practices and Quality of Care: Evidence from the Private Health Care Sector in Tanzania

• 成果类型: Article
• 署名作者: Powell-Jackson, Timothy; King, Jessica J. C.; Makungu, Christina; Quaife, Matthew; Goodman, Catherine
• 署名单位: University of London; London School of Hygiene & Tropical Medicine; Ifakara Health Institute
• 刊物名称: ECONOMIC JOURNAL
• ISSN/ISSBN: 0013-0133
• DOI: 10.1093/ej/uead075
• 发表日期: 2023
• 页码: 436-456
• 关键词: clinical-quality; low-income; performance; facilities; patient; systems; FIRMS; gap

摘要

We measure the adoption of management practices in over 220 private for-profit and non-profit health facilities in 64 districts across Tanzania and link these data to process quality-of-care metrics, assessed using undercover standardised patients and clinical observations. We find that better managed health facilities are more likely to provide correct treatment in accordance with national treatment guidelines, adhere to a checklist of essential questions and examinations, and comply with infection prevention and control practices. Moving from the 10th to the 90th percentile in the management practice score is associated with a 48% increase in correct treatment. We then leverage a large-scale field experiment of an internationally recognised management support intervention in which health facilities are assessed against comprehensive standards, given an individually tailored quality improvement plan and supported through training and mentoring visits. We find zero to small effects on management scores, suggesting that improving management practices in this setting may be challenging.