Management Practices and Quality of Care: Evidence from the Private Health Care Sector in Tanzania
The Economic Journal · 2024 · Timothy Powell-Jackson、Jessica J C King、Christina Makungu、Matthew Quaife、Catherine Goodman
中文摘要
我们测量了坦桑尼亚64个县中220多家私立营利性与非营利性医疗机构对管理实践的采用情况,并将这些数据与医疗过程质量指标相联系,后者通过暗访标准化病人和临床观察进行评估。我们发现,管理更好的医疗机构更有可能按照国家治疗指南提供正确治疗、遵循包含基本问诊与检查项目的清单,并遵守感染预防与控制规范。管理实践得分从第10百分位提升至第90百分位,与正确治疗增加48%相关联。随后,我们利用一项大规模田野实验,评估一项国际认可的管理支持干预:在该干预中,医疗机构依据全面标准接受评估,获得量身定制的质量改进计划,并通过培训与辅导访问获得支持。我们发现该干预对管理得分的效应为零至较小,这表明在此情境下改善管理实践可能具有挑战性。
Abstract
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.