Working Paper: NBER ID: w31203
Authors: Guadalupe Bedoya; Jishnu Das; Amy Dolinger
Abstract: We report results from the first randomization of a regulatory reform in the health sector. The reform established minimum quality standards for patient safety, an issue that has become increasingly salient following the Ebola and COVID-19 epidemics. In our experiment, all 1348 health facilities in three Kenyan counties were classifi ed into 273 markets, and the markets were then randomly allocated to treatment and control groups. Government inspectors visited health facilities and, depending on the results of their inspection, recommended closure or a timeline for improvements. The intervention increased compliance with patient safety measures in both public and private facilities (more so in the latter) and reallocated patients from private to public facilities without increasing out-of-pocket payments or decreasing facility use. In treated markets, improvements were equally marked throughout the quality distribution, consistent with a simple model of vertical differentiation in oligopolies. Our paper thus establishes the use of experimental techniques to study regulatory reforms and, in doing so, shows that minimum standards can improve quality across the board without adversely affecting utilization.
Keywords: Minimum Quality Standards; Health Markets; Patient Safety; Regulatory Reform; Randomized Controlled Trial
JEL Codes: H75; I11; I18; O17
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Minimum Quality Standards (MQS) (L15) | Compliance with patient safety measures (I18) |
| Minimum Quality Standards (MQS) (L15) | Compliance with patient safety measures (Private Facilities) (I18) |
| Minimum Quality Standards (MQS) (L15) | Compliance with patient safety measures (Public Facilities) (I18) |
| Minimum Quality Standards (MQS) (L15) | Reallocation of patients from private to public facilities (I18) |
| Minimum Quality Standards (MQS) (L15) | Prices for patients (P22) |
| Minimum Quality Standards (MQS) (L15) | Facility utilization (R53) |
| Minimum Quality Standards (MQS) (L15) | Market dynamics and access to care (I11) |
| Minimum Quality Standards (MQS) (L15) | Investments in infrastructure and equipment (H54) |