Inequality in the Quality of Health Services : Wealth, Content of Care, and Price of Antenatal Consultations in the Democratic Republic of Congo
Using unique direct observations of patient-provider interactions linked to patient exit interviews and detailed household surveys, this paper assesses the relationship between patient wealth and the quality and price of antenatal care in the Democ...
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| Language: | English |
| Published: |
World Bank, Washington, DC
2019
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| Online Access: | http://documents.worldbank.org/curated/en/851111555342898988/Inequality-in-the-Quality-of-Health-Services-Wealth-Content-of-Care-and-Price-of-Antenatal-Consultations-in-the-Democratic-Republic-of-Congo http://hdl.handle.net/10986/31560 |
| Summary: | Using unique direct observations of
patient-provider interactions linked to patient exit
interviews and detailed household surveys, this paper
assesses the relationship between patient wealth and the
quality and price of antenatal care in the Democratic
Republic of Congo. Overall, the analysis finds a significant
wealth-quality gradient, with a standard deviation increase
in wealth being associated with an increase of 4 percentage
points in protocol compliance. This increase in compliance
represents 8 percent of the average quality of care received
by women in the lowest wealth quintile. Over half of the
wealth-quality gradient is driven by lower facility quality
in poorer areas. However, the analysis also finds
statistically significant within-village and even
within-facility wealth-quality relationships. Within
villages, wealth-quality gradients are primarily driven by
wealthier women seeking care at higher-quality even if more
distant facilities. Within the same facilities, poorer women
tend to receive worse care, but on average they also pay
less for the same quality of care compared with wealthier
women. The price gap increases in the local ratio of wealthy
to poor households, suggesting that providers do not charge
different prices only for redistributive reasons. |
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