Does high workload reduce the quality of healthcare? Evidence from rural Senegal

Kovacs, Roxanne; Lagarde, Mylène

doi:10.1016/j.jhealeco.2022.102600

Cited by 14 publications

(11 citation statements)

References 44 publications

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“…Consequently, this suggests that patients continue to perceive a shortage of healthcare workers, despite the allocation of additional resources to address waiting times. These findings are consistent with global studies, including reports from the WHO, which emphasizes the critical shortage of healthcare professionals in many low-income countries [12], including Tanzania. Similar studies in Pakistan [13], Nigeria [14], Kenya [15] and another study that was conducted in rural Tanzania [16] all highlight that a scarcity of healthcare providers contribute to extended waiting time, stressing the need for an adequate workforce to manage patient flow and improve healthcare delivery.…”

Section: Discussionsupporting

confidence: 91%

“…Studies have consistently identified the shortage of healthcare staff as factor contributing to prolonged waiting time within the OPD. The World Health Organization (WHO) approximates that in 90% of low-income countries, there is a significant shortage of healthcare professionals, defined by having fewer than 4.4 qualified staff members per 1000 individuals [12]. A study conducted by Safdar et al, (2020) aimed to create a model for assessing queues to analyse the influx of walk-in outpatients in a busy public hospital in Pakistan.…”

Section: Introductionmentioning

confidence: 99%

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Outcome evaluation of effect of organizational strategies on reduction of patient waiting time at the outpatient department at Kilimanjaro Christian Medical Centre – Northern, Tanzania

Mollel,

Mwanswila

2024

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Background The Tanzanian healthcare system has long grappled with extended waiting times in outpatient departments (OPD). Studies at Kilimanjaro Christian Medical Centre (KCMC) revealed an average wait of six hours, marking KCMC with the longest waiting time among Tanzanian referral hospitals. Thus, this study was undertaken to assess the efficacy of the programme interventions and their effect on waiting time at KCMC, OPD. Methods An analytical cross-sectional approach quantitatively and qualitatively examined the subject. The study enrolled 412 patients who completed structured questionnaires, while 14 participants underwent in-depth interviews (ID) (8 healthcare providers, 6 patients) from 3rd to 14th, 2023. Documentary review supplemented data. Quantitative analysis included descriptive statistics, bivariable, and multivariable techniques. Qualitative data underwent thematic analysis. Significance tests were at a 5% level. Result The overall OPD waiting time significantly decreased to 3.30 hours IQR (2.51-4.08) in contrast to the previous 6 hours prior to the intervention, showing the effectiveness of the intervention achieving a reduction of waiting time by 55%. Improvements were particularly evident, waiting time for registration (9 minutes), payments (10 minutes), triage (14 minutes for patients with insurance) and pharmacy (4 minutes). The implementation of Ushers emerged as a significant predictor to patient waiting time (AOR = 2.08, 95% CI, 1.10-3.94, p-value=0.025). Based on the IDI, the findings indicate a favourable change in patients' attitudes towards waiting time at the OPD. However, there is skepticism regarding the expansion of hospital infrastructure and its effect on waiting time, as well as reliance on auxiliary support due to insufficient human resources. Conclusion Even though the established intervention strategies have managed to reduce waiting time, additional measures to attain the global standard of waiting time from 30 minutes to 2 hours are needed.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Outcome evaluation of effect of organizational strategies on reduction of patient waiting time at the outpatient department at Kilimanjaro Christian Medical Centre – Northern, Tanzania

Mollel,

Mwanswila

2024

Preprint

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“…Our findings suggest that physician over-service improves health care quality under a fee-for-service financing system in primary care in China. Our findings support the conclusion that physicians are less motivated and do not reach their production possibility frontier in practice in developing countries (Kovacs and Lagarde, 2022). Physician over-service can, at least partly, attenuate their ‘know-do’ gaps (see Figure 3 Panel C ).…”

Section: Discussionsupporting

confidence: 89%

Does Physician Over-Service Improve the Quality of Care? A Standardised Patient Audit Study

Si,

Bateman,

Chen

et al. 2023

Preprint

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Physicians’ “know-do gaps” are a key factor driving the poor quality of healthcare in many developing countries, but there is little guidance on how to address these gaps. We designed a standardised patient audit study in China to evaluate the impact of physician over-service on their investment in learning and disease management decisions. We find that physicians’ total over-service leads to a 19.2%, 15.6% and 10.8% significant increase in consultation length, adherence to checklists, and patient-centred communication, respectively, but no significant improvement in giving a correct diagnosis, drug prescription or referral. The effects on physicians’ investment in learning are driven by over-service in drug prescription rather than over-service in medical tests. Moreover, over-service in drug prescription significantly leads to a 28.0 percentage-point increase in the prescription of a correct drug. Our findings imply that physician over-service reduces their “know-do gaps” and improves healthcare quality despite the related inefficient use of medical resources.JEL classificationD82; H75; I10; I11; I18; J45

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“…This study deepens our understanding of physicians' decision-making process and sheds light on the potential to achieve higher-quality care in clinical practice through, for example, improving patient-centered communications and shifting effort from the treatment stage to the earlier stage of consultation, without creating excessive workloads for physicians and additional medical expenses for patients. Our findings also help us to understand the mechanism of physicians' knowdo gaps identified in medical practice (Leonard and Masatu, 2010;Mohanan et al, 2015) and the widely held notion that current health systems in many developing countries fail to motivate physicians to reach their productivity frontier in practice (Kovacs and Lagarde, 2022). For policy makers, compared with the traditional perception of using a clinicaltraining strategy, designing innovative interventions to improve patient centeredness and to incentivize physicians' efforts in consultation can lead to substantial gains in the use of some inexpensive but potentially lifesaving diagnoses and treatments and equalize gender inequality in medical care.…”

Section: Discussionmentioning

confidence: 83%

The Impact of Physician-Patient Gender Match on Healthcare Quality: An Experiment in China

Si,

Chen,

et al. 2023

Preprint

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Despite growing evidence of gender disparities in healthcare utilization and health outcomes, there is a lack of understanding of what may drive such differences. Designing and implementing an experiment using the standardized patients’ approach, we present novel evidence on the impact of physician-patient gender match on healthcare quality in a primary care setting in China. We find that, compared with female physicians treating female patients, the combination of female physicians treating male patients resulted in a 23.0 percentage-point increase in correct diagnosis and a 19.4 percentage-point increase in correct drug prescriptions. Despite these substantial gains in healthcare quality, there was no significant increase in medical costs and time investment. Our analyses suggest that the gains in healthcare quality were mainly attributed to better physician-patient communications, but not the presence of more clinical information. This paper has policy implications in that improving patient centeredness and incentivizing physicians’ efforts in consultation (as opposed to treatment) can lead to significant gains in the quality of healthcare with modest costs, while reducing gender differences in care.

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Does high workload reduce the quality of healthcare? Evidence from rural Senegal

Cited by 14 publications

References 44 publications

Outcome evaluation of effect of organizational strategies on reduction of patient waiting time at the outpatient department at Kilimanjaro Christian Medical Centre – Northern, Tanzania

Outcome evaluation of effect of organizational strategies on reduction of patient waiting time at the outpatient department at Kilimanjaro Christian Medical Centre – Northern, Tanzania

Does Physician Over-Service Improve the Quality of Care? A Standardised Patient Audit Study

The Impact of Physician-Patient Gender Match on Healthcare Quality: An Experiment in China

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