Can patients improve the quality of care they receive? Experimental evidence from Senegal. (February 2022)

• Record Type: Journal Article
• Authors: Kovacs, Roxanne J.; Lagarde, Mylene; Cairns, John
• Is Part Of: World development. Volume 150(2022)
• Publication Date: 2022-02
• Subjects: Quality of care -- Field experiment -- Patient behaviour -- Provider behaviour -- Patient-provider interaction -- Standardised patients -- Communication -- Senegal; Economic history -- 1990- -- Periodicals; Economic assistance -- Developing countries -- Periodicals; 330.9
• DOI: 10.1016/j.worlddev.2021.105740
• Languages: English
• ISSNs: 0305-750X

Abstract

Highlights: We use standardised patients to test if quality of care increases when patients share more information in rural Senegal Providers are 27% more likely to correctly manage patients who volunteer more information at the start of the consultation Low performance when patients share less information is not due to providers' lack of knowledge or clinical skills Instead, low motivation may limit providers' ability to adapt their effort to patients' inputs in the consultation. Encouraging patients to be more active in consultations could improve the quality of healthcare in low-income settings. Abstract: Providers in many low and middle-income countries (LMICs) often fail to correctly diagnose and treat their patients, even though they have the clinical knowledge to do so. Against the backdrop of many failed attempts to increase provider effort, this study examines whether quality of care can be improved by encouraging patients to be more active during consultations. We design a simple experiment with undercover standardised patients who randomly vary how much information they disclose about their symptoms. We find that providers are 27% more likely to correctly manage a patient who volunteers several key symptoms of their condition at the start of the consultation, compared to a typical patient who shares less information. Lower performance in the control group is not due to providers' lack of knowledge, an incapacity to ask the right questions, or a response to time or resource constraints. Instead, providers' low motivation seems to limit their ability to adapt their effort to patients' inputs in the consultation. Our findings provide proof-of-concept evidence that interventions making patients more active in their consultations could significantly improve the quality of care in LMICs.