Quality and Accountability in Health Care Delivery: Audit-Study Evidence from Primary Care in India

Am Econ Rev. 2016 Dec;106(12):3765-99. doi: 10.1257/aer.20151138.


We present unique audit-study evidence on health care quality in rural India, and find that most private providers lacked medical qualifications, but completed more checklist items than public providers and recommended correct treatments equally often. Among doctors with public and private practices, all quality metrics were higher in their private clinics. Market prices are positively correlated with checklist completion and correct treatment, but also with unnecessary treatments. However, public sector salaries are uncorrelated with quality. A simple model helps interpret our findings: Where public-sector effort is low, the benefits of higher diagnostic effort among private providers may outweigh costs of potential overtreatment.

MeSH terms

  • Checklist
  • Clinical Audit*
  • Clinical Competence*
  • Cost-Benefit Analysis
  • Delivery of Health Care
  • Diagnosis
  • Humans
  • India
  • Primary Health Care*
  • Private Sector*
  • Public Sector*
  • Quality of Health Care*
  • Rural Population
  • Unnecessary Procedures