Study Overview
Country studies from Indonesia, Tanzania, India, Paraguay, and Mexico document the quality of medical advice and variation in practice quality across a number of dimensions. This overview paper serves three purposes. First, the studies use several different measures; we contextualize these measures and discuss how they relate to each other. Second, we propose a three-way decomposition to analyze variations in the quality of care. These variations can arise from inequalities in access, inequalities in choices, or inequalities arising from discrimination. We discuss common elements across the studies and draw policy implications for future research and advocacy.
Study Results
The overall quality of care documented in these studies is low, although there is considerable variation across countries and even within countries over time. These studies present a strong case that despite very different settings, the quality of medical advice can and should be measured. They also provide evidence that increasing the availability of medical care is not enough. Variations in practice quality rather than variations in availability and structural quality are more likely to explain a large fraction of the variance in health outcomes, even in low-income settings.