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Survey using incognito standardized patients shows poor quality care in China's rural clinics
Sean Sylvia1, Yaojiang Shi2, Hao Xue1
1School of Economics, Renmin University of China, 59 Zhongguancun Avenue, Beijing, 100872 China, Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, 199 South Chang'an Road, Xi'an, Shaanxi, 710062 China, School of Economics and Management, Northwest University, No. 1 Xuefu Da Road, Xi'an, Shaanxi, 710127 China, Shaanxi No. 4 Provincial People's Hospital, 512 Xianning East Rd, Xi'an, Shaanxi, 710043 China and Freeman Spogli Institute for International Studies, Stanford University, 616 Serra Street, Stanford, CA 94305, USA.
Abstract:
Over the past decade, China has implemented reforms designed to expand access to health care in rural areas. Little objective evidence exists, however, on the quality of that care. This study reports results from a standardized patient study designed to assess the quality of care delivered by village clinicians in rural China. To measure quality, we recruited individuals from the local community to serve as undercover patients and trained them to present consistent symptoms of two common illnesses (dysentery and angina). Based on 82 covert interactions between the standardized patients and local clinicians, we find that the quality of care is low as measured by adherence to clinical checklists and the rates of correct diagnoses and treatments. Further analysis suggests that quality is most strongly correlated with provider qualifications. Our results highlight the need for policy action to address the low quality of care delivered by grassroots providers.
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