Strained Mercy

The quality of medical care is a potentially important determinant of health outcomes, but remains an understudied area. The limited research that exists defines quality either on the basis of drug availability or facility characteristics, but little is known about how provider quality affects the provision of health care. We address this gap through a survey in Delhi with two related components. We evaluate 'competence' (what providers know) through vignettes and practice (what providers do) through direct clinical observation. Overall quality, as measured by the competence necessary to recognise and handle common and dangerous conditions, is quite low albeit with tremendous variation. While there is some correlation with simple observed characteristics, there is still an enormous amount of variation within such categories. Further, even when providers know what to do they often don't do it in practice. This appears to be true in both the public and private sectors but for very different, and systematic, reasons. The study has important policy implications for our understanding of how market failures and failures of regulation in the health sector affect the poor.