World Bank: Health & Population (Topic)最新文献

{"title":"Strained Mercy: The Quality of Medical Care in Delhi","authors":"Jishnu Das, J. Hammer","doi":"10.1596/1813-9450-3228","DOIUrl":"https://doi.org/10.1596/1813-9450-3228","url":null,"abstract":"The quality of medical care is a potentially important determinant of health outcomes. Nevertheless, it remains an understudied area. The limited research that exists defines quality either on the basis of drug availability or facility characteristics, but little is known about how provider quality affects the provision of health care. The authors address this gap through a survey in Delhi with two related components. They evaluate\"competence\"(what providers know) through vignettes and practice (what providers do) through direct clinical observation. Overall quality as measured by the competence necessary to recognize and handle common and dangerous conditions is quite low, albeit with tremendous variation. While there is some correlation with simple observed characteristics, there is still an enormous amount of variation within such categories. Further, even when providers know what to do they often do not do it in practice. This appears to be true in both the public and private sectors though for very different, and systematic, reasons. In the public sector providers are more likely to commit errors of omission-they are less likely to exert effort compared with their private counterparts. In the private sector, providers are prone to errors of commission-they are more likely to behave according to the patient's expectations, resulting in the inappropriate use of medications, the overuse of antibiotics, and increased expenditures. This has important policy implications for our understanding of how market failures and failures of regulation in the health sector affect the poor.","PeriodicalId":184810,"journal":{"name":"World Bank: Health & Population (Topic)","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114893809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To Serve the Community or Oneself: The Public Servant's Dilemma","authors":"A. Barr, M. Lindelow, P. Serneels","doi":"10.1596/1813-9450-3187","DOIUrl":"https://doi.org/10.1596/1813-9450-3187","url":null,"abstract":"Embezzlement of resources is hampering public service delivery throughout the developing world. Research on this issue is hindered by problems of measurement. To overcome these problems, the authors use an economic experiment to investigate the determinants of corrupt behavior. They focus on three aspects of behavior: 1) Embezzling by public servants. 2) Monitoring effort by designated monitors. 3) Voting by community members when provided with an opportunity to select a monitor. The experiment allows the authors to study the effect of wages, effort observance, rules for monitor assignment, and professional norms. Their experimental subjects are Ethiopian nursing students. The authors find that service providers who earn more embezzle less, although the effect is small. Embezzlement is also lower when observance (associated with the risk of being caught and sanctioned) is high, and when service providers face an elected, rather than a randomly selected monitor. Monitors put more effort into monitoring when they face reelection, and when the public servant receives a higher wage. Communities reelect monitors who put more effort into exposing embezzlement. Framing-whereby players are referred to as\"health workers\"and\"community members\"rather than by abstract labels-affects neither mean embezzlement nor mean monitoring effort, but significantly increases the variance in both. This suggests that different types of experimental subjects respond differently to the framing, possibly because they adhere to different norms.","PeriodicalId":184810,"journal":{"name":"World Bank: Health & Population (Topic)","volume":"309 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122518804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic Analysis of Health Care Utilization and Perceived Illness: Ethnicity and Other Factors","authors":"V. Paqueo, C. Gonzalez","doi":"10.1596/1813-9450-3125","DOIUrl":"https://doi.org/10.1596/1813-9450-3125","url":null,"abstract":"Paqueo and Gonzalez look at the determinants of health-seeking behavior of the Mexican population and within this context focus on the effect of ethnicity. They address the following questions: To what extent are the indigenous people at a disadvantage health care-wise and in what particular health services are they disadvantaged? Is the health care gap due to indigenous cultures by itself as opposed to the impact of socioeconomic differences? What policy instruments can be used to reduce the gap? The authors find that contrary to expectations, the indigenous people in Mexico tend to have a positive behavior toward modern preventive care compared with the nonindigenous population, holding socioeconomic factors constant. Apparently, there is no cultural barrier in regard to these services. But ethnicity remains negatively associated with the use of inpatient hospital care and medical and dental consultations. Insurance has a significant and positive effect on health care use. Therefore, it appears to be an effective instrument for addressing the health care disadvantages faced by the indigenous population in regard to inpatient care and the use of outpatient services of doctors, nurses, and dentists.","PeriodicalId":184810,"journal":{"name":"World Bank: Health & Population (Topic)","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2003-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126477440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ghost Doctors: Absenteeism in Bangladeshi Health Facilities","authors":"N. Chaudhury, J. Hammer","doi":"10.1093/WBER/LHH047","DOIUrl":"https://doi.org/10.1093/WBER/LHH047","url":null,"abstract":"The authors report on a study in which unannounced visits were made to health clinics in Bangladesh with the intention of discovering what fraction of medical professionals were present at their assigned post. This survey represents the first attempt to quantify the extent of the problem on a nationally representative scale. Nationwide the average number of vacancies over all types of providers in rural health centers is 26 percent. Regionally, vacancy rates (unfilled posts) are generally higher in the poorer parts of the country. Absentee rates at over 40 percent are particularly high for doctors. When separated into level of facility, the absentee rate for doctors at the larger clinics is 40 percent, but at the smaller sub-centers with a single doctor, the rate is 74 percent. Even though the primary purpose of this survey is to document the extent of the problem among medical staff, the authors also explore the determinants of staff absenteeism. Whether the medical provider lives near the health facility, access to a road, and rural electrification are important determinants of the rate and pattern of staff absentee rates.","PeriodicalId":184810,"journal":{"name":"World Bank: Health & Population (Topic)","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2003-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134571864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vulnerability in Consumption, Education, and Health: Evidence from Moldova During the Russian Crisis","authors":"Edmundo Murrugarra, J. Signoret","doi":"10.1596/1813-9450-3010","DOIUrl":"https://doi.org/10.1596/1813-9450-3010","url":null,"abstract":"The authors analyze the widespread effects of the financial crisis in Russia to explore the vulnerabilities of households in Moldova. They show that the crisis had differential impacts on households, affecting most the urban and better-off. Households' decisions about education and health resulted in decreased utilization and expenditures. The enrollment of young children from better-off households did not improve while others did. Secondary school enrollment of children from better-off households decreased after the crisis, in part because of the need to release labor supply. Health utilization decreased mainly for primary health care (not for hospitals), both for better-off households and in rural areas. Some of these changes are due to limited household resources (health), decreased public spending (health and education) or the need to increase households' labor supply (education of teenagers). Social benefits played a very limited role in mitigating these effects, solely in health care use. Households' assets helped to offset some of the negative effects of declining incomes.","PeriodicalId":184810,"journal":{"name":"World Bank: Health & Population (Topic)","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2003-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126626370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Strategic Use and Potential Demand for an HIV Vaccine in Southern Africa","authors":"C. Desmond, R. Greener","doi":"10.1596/1813-9450-2977","DOIUrl":"https://doi.org/10.1596/1813-9450-2977","url":null,"abstract":"HIV prevalence in Southern Africa is the highest in the world and the impact of HIV/AIDS in the region are devastating at all levels of society, including the wider economy. Government response has lagged behind the pace of the epidemic, but programs are now beginning to focus on a broad range of interventions to combat its further spread and to mitigate its impact. The authors investigate the issues around the targeting of an eventual HIV vaccine. There is at present no vaccine against HIV. Although several candidates are in the trial stage, it is not likely that a vaccine effective against the sub-type of the virus prevalent in Southern Africa will be available for 10-15 years. When it is, it may be expensive, only partially effective, and confer immunity for a limited period only. Vaccination programs will need to make the best use of the vaccine that is available and effective targeting will be essential. The authors identify potential target groups for a vaccine, and estimate how many individuals would be in need of vaccination. They develop a method for estimating how many cases of HIV infection are likely to be avoided for each vaccinated individual. The cases avoided are of two kinds: primary-the individual case that might have occurred in people who are vaccinated, and secondary-the number of people that the vaccinated individual would otherwise have caused to become infected. Both of these depend on assumptions about the efficacy and duration of vaccine protection and the extent and nature of sexual risk behavior in the population groups. The authors distinguish between the HIV cases averted per vaccination and the cases averted per 100 recruits into a vaccination program. The cases averted per 100 recruits is used to develop a priority ranking of the identified population groups for vaccination. The authors discuss the issue of ease of access to those groups and how the differential costs would affect the vaccination strategy. They conclude that an expensive vaccine should be administered to commercial sex workers first, while an inexpensive vaccine would be better administered first to general population groups, in particular, schoolchildren. The authors conclude with a discussion of current levels of public and private expenditure on HIV prevention and treatment, and the implications for an assessment of the willingness to pay for an eventual HIV vaccine.","PeriodicalId":184810,"journal":{"name":"World Bank: Health & Population (Topic)","volume":"355 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2003-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115933951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short But Not Sweet: New Evidence on Short Duration Morbidities from India","authors":"Jishnu Das, Carolina Sánchez-Páramo","doi":"10.1596/1813-9450-2971","DOIUrl":"https://doi.org/10.1596/1813-9450-2971","url":null,"abstract":"India spends 6 percent of its GDP on health - three times the amount spent by Indonesia and twice that of China - and spending on non-chronic morbidities is three times that of chronic illnesses. It is normally assumed that the high spending on non-chronic illnesses reflects the prevalence of morbidities with high case-fatality or case-disability ratios. But there is little data that can be used to separate out spending by type of illness. Das and Sanchez-Paramo address this issue with a unique dataset where 1,621 individuals in Delhi were observed for 16 weeks through detailed weekly interviews on morbidity and health-seeking behavior. The authors' findings are surprising and contrary to the normal view of health spending. They define a new class of illnesses as \"short duration morbidities\" if they are classified as non-chronic in the international classification of disease and are medically expected to last less than two weeks. The authors show that short duration morbidities are important in terms of prevalence, practitioner visits, and household health expenditure: Individuals report a short duration morbidity in one out of every five weeks. Moreover, one out of every three weeks reported with a short duration morbidity results in a doctor visit, and each week sick with such a morbidity increases health expenditure by 25 percent. Further, the absolute spending on short duration morbidities is similar across poor and rich income households. The authors discuss the implications of these findings in understanding household health behavior in an urban context, with special emphasis on the role of information in health-seeking behavior. This paper - a product of Public Services, Development Research Group - is part of a larger effort in the group to understand health expenditures.","PeriodicalId":184810,"journal":{"name":"World Bank: Health & Population (Topic)","volume":"os-53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127793165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Valuing Mortality Reductions in India: A Study of Compensating-Wage Differentials","authors":"M. Cropper, N. Simon, A. Alberini, S. Arora","doi":"10.1596/1813-9450-2078","DOIUrl":"https://doi.org/10.1596/1813-9450-2078","url":null,"abstract":"Conducting cost-benefit analyses of health and safety regulations requires placing a dollar value on reductions in health risks, including the risk of death. In the United States, mortality risks are often valued using compensating-wage differentials. These differentials measure what a worker would have to be paid to accept a small increase in his risk of death-which is assumed to equal what the worker would pay to achieve a small reduction in his risk of death. The authors estimate compensating-wage differentials for risk of fatal and nonfatal injuries in India's manufacturing industry. They estimate a hedonic wage equation using the most recent Occupational Wage Survey, supplemented by data on occupational injuries from the Indian Labour Yearbook. Their estimates of compensating-wage differentials imply a value of statistical life (VSL) in India of 6.4 million to 15 million 1990 rupees (roughly $150,000 to $360,000 at current exchange rates). This number is between 20 and 48 times forgone earnings-the human capital measure of the value of reducing the risk of death. The ratio of the VSL to forgone earnings implied by the study is larger than in comparable U.S. studies but smaller than the ratio implied by the only other compensating-wage study for India (Shanmugam 1997). The latter implies a ratio of VSL to forgone earnings of 73! The authors caution that in India, as in the United States, compensating-wage differentials in the labor market may overstate what individuals would themselves pay to reduce the risk of death. They suggest using their estimates as an upper bound on willingness to pay to reduce risk of death, and forgone earnings as a lower bound.","PeriodicalId":184810,"journal":{"name":"World Bank: Health & Population (Topic)","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127588252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}