Okeke (2022) Flashcards
core research question
what is the effect of having access to a trained physician on individual patient care and outcomes as opposed to untrained or less trained staff?
does boosting access to doctors reduce infant deaths?
estimation of a quantity effect and quality effect
- having an additional staff person
- having an MD vs. MLP
experimental design
placement of doctors to health facilities randomised
background
roughly 0.3 practicing MDs per 1000 population
- 3 per 1000 in the US/UK and other wealthy countries
- far lower rates in rural areas
Nigeria has some of the highest rates of infant, child and maternal mortality in the world
first finding: the program worked
treatment ended up being delivered and doctors were working
nearly perfect compliance with assigned treatments
second finding: immediate reduction in neonatal mortality
doctor posted improves child survival
quantity effects diminish in the short-run but quality effects are more persistent in the long-run
dose response
- the longer the period of time the doctor is there, the longer they are able to oversee the pregnancy which limits complications post-birth
- overall effect starts small but every additional month the doctor is there has more effect
third finding: effect on 7-day mortality
larger effect with doctors than MLPs
- gaining access to an MD leads to a greater reduction in infant mortality depending on covariates (15-21% reduction)
- an additional MLP does not meaningfully affect mortality
bottom-line of Okeke’s findings
quality of training and skill level of health providers have an important impact on patient outcomes
- human capital and education are critical
more quantity alone does not have a measurable impact
different skill levels of physicians
doctors at 80% compared to 40/50% of MLPs
- quality of care into an index
MD at the 20th percentile of the proficiency distribution is roughly comparable to an MLP at the 80th percentile
