Healthy competition? Market structure and the quality of clinical care given to standardised patients in Tanzania

IF 4.9 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Timothy Powell-Jackson , Jessica J.C. King , Christina Makungu , Catherine Goodman
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引用次数: 0

Abstract

The private health care sector in many low- and middle-income countries is rapidly expanding. Private sector advocates have long argued that market competition drives private providers to become more efficient and responsive to patients but empirical studies are limited to mostly high-income settings. We examine whether the number of competing health facilities in close proximity is associated with quality and prices, in a sample of 228 private for-profit and faith-based facilities in Tanzania. Primary data collection took place in the health facilities between February and June 2018. By exploiting data on the quality of clinical care given to unannounced standardised patients, we are able to compare quality across providers without confounding due to patient characteristics. We find that more local competition is associated with poorer clinical quality. The former is driven by an increase in unnecessary care rather than a reduction in appropriate care. Policymakers in such settings should be cautious in assuming that market competition will drive up quality of care.
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来源期刊
Social Science & Medicine
Social Science & Medicine PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
9.10
自引率
5.60%
发文量
762
审稿时长
38 days
期刊介绍: Social Science & Medicine provides an international and interdisciplinary forum for the dissemination of social science research on health. We publish original research articles (both empirical and theoretical), reviews, position papers and commentaries on health issues, to inform current research, policy and practice in all areas of common interest to social scientists, health practitioners, and policy makers. The journal publishes material relevant to any aspect of health from a wide range of social science disciplines (anthropology, economics, epidemiology, geography, policy, psychology, and sociology), and material relevant to the social sciences from any of the professions concerned with physical and mental health, health care, clinical practice, and health policy and organization. We encourage material which is of general interest to an international readership.
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