Development Research Group
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Health economics, Education, Gender, Health, Microeconomics, Cultural economics, India, Pakistan, Kenya, Zambia, Macroeconomic and Structural Policies
Development Research Group
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Last updated January 31, 2023
Jishnu Das is a Lead Economist in the Development Research Group (Human Development Team) at the World Bank and a Visiting Fellow at the Center for Policy Research, New Delhi. Jishnu’s work focuses on the delivery of basic services, particularly health and education. He has worked on the quality of health care, mental health, information in health and education markets, child learning and test-scores and the determinants of trust. His work has been published in leading economics, health and education journals and widely covered in the media and policy forums. In 2011 he was part of the core team on the World Development Report on Gender and Development. He received the George Bereday Award from the Comparative and International Education Society and the Stockholm Challenge Award for the best ICT project in the public administration category in 2006, and the Research Academy award from the World Bank in 2013. He is currently working on long-term projects on health and education markets in India and Pakistan.
Publication Search Results
Now showing 1 - 10 of 16
Publication(World Bank, Washington, D.C., 2004-05) Das, Jishnu ; Hammer, JeffreyThe authors develop a method in which vignettes-a battery of questions for hypothetical cases-are evaluated with item response theory to create a metric for doctor quality. The method allows a simultaneous estimation of quality and validation of the test instrument that can be used for further refinements. The authors apply the method to a sample of medical practitioners in Delhi, India. The method gives plausible results, rationalizes different perceptions of quality in the public and private sectors, and pinpoints several serious problems with health care delivery in urban India. The findings confirm, for instance, that the quality of private providers located in poorer areas of the city is significantly lower than those in richer neighborhoods. Surprisingly, similar results hold for providers in the public sector, with important implications for inequities in the availability of health care.
Publication(World Bank, Washington, D.C., 2004-03) Das, Jishnu ; Hammer, Jeffrey S.The quality of medical care is a potentially important determinant of health outcomes. Nevertheless, it 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. The authors address this gap through a survey in Delhi with two related components. They 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 recognize 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 do not do it in practice. This appears to be true in both the public and private sectors though for very different, and systematic, reasons. In the public sector providers are more likely to commit errors of omission-they are less likely to exert effort compared with their private counterparts. In the private sector, providers are prone to errors of commission-they are more likely to behave according to the patient's expectations, resulting in the inappropriate use of medications, the overuse of antibiotics, and increased expenditures. This has important policy implications for our understanding of how market failures and failures of regulation in the health sector affect the poor.
Publication(American Economic Association, 2013-04) Das, Jishnu ; Dercon, Stefan ; Habyarimana, James ; Krishnan, Pramila ; Muralidharan, Karthik ; Sundararaman, VenkateshEmpirical studies of the relationship between school inputs and test scores typically do not account for household responses to changes in school inputs. Evidence from India and Zambia shows that student test scores are higher when schools receive unanticipated grants, but there is no impact of grants that are anticipated. We show that the most likely mechanism for this result is that households offset their own spending in response to anticipated grants. Our results confirm the importance of optimal household responses and suggest caution when interpreting estimates of school inputs on learning outcomes as parameters of an education production function.
Publication(World Bank, Washington, DC, 2003-02) Das, Jishnu ; Sánchez-Páramo, CarolinaIndia spends 6 percent of its GDP on health-three times the amount spent by Indonesia and twice that of China-and spending on non-chronic morbidities is three times that of chronic illnesses. It is normally assumed that the high spending on non-chronic illnesses reflects the prevalence of morbidities with high case-fatality or case-disability ratios. But there is little data that can be used to separate out spending by type of illness. The authors address this issue with a unique dataset where 1,621 individuals in Delhi were observed for 16 weeks through detailed weekly interviews on morbidity and health-seeking behavior. The authors' findings are surprising and contrary to the normal view of health spending. They define a new class of illnesses as "short duration morbidities" if they are classified as non-chronic in the international classification of disease and are medically expected to last less than two weeks. The authors show that short duration morbidities are important in terms of prevalence, practitioner visits, and household health expenditure: Individuals report a short duration morbidity in one out of every five weeks. Moreover, one out of every three weeks reported with a short duration morbidity results in a doctor visit, and each week sick with such a morbidity increases health expenditure by 25 percent. Further, the absolute spending on short duration morbidities is similar across poor and rich income households. The authors discuss the implications of these findings in understanding household health behavior in an urban context, with special emphasis on the role of information in health-seeking behavior.
India Shining and Bharat Drowning : Comparing Two Indian States to the Worldwide Distribution in Mathematics Achievement(World Bank, Washington, DC, 2008-06) Das, Jishnu ; Zajonc, TristanThis paper uses student answers to publicly released questions from an international testing agency together with statistical methods from Item Response Theory to place secondary students from two Indian states -Orissa and Rajasthan -on a worldwide distribution of mathematics achievement. These two states fall below 43 of the 51 countries for which data exist. The bottom 5 percent of children rank higher than the bottom 5 percent in only three countries-South Africa, Ghana and Saudi Arabia. But not all students test poorly. Inequality in the test-score distribution for both states is next only to South Africa in the worldwide ranking exercise. Consequently, and to the extent that these two states can represent India, the two statements "for every ten top performers in the United States there are four in India" and "for every ten low performers in the United States there are two hundred in India" are both consistent with the data. The combination of India's size and large variance in achievement give both the perceptions that India is shining even as Bharat, the vernacular for India, is drowning. Comparable estimates of inequalities in learning are the building blocks for substantive research on the correlates of earnings inequality in India and other low-income countries; the methods proposed here allow for independent testing exercises to build up such data by linking scores to internationally comparable tests.
Publication(World Bank, 2009-02-28) Das, Jishnu ; Do, Quy-Toan ; Friedman, Jed ; McKenzie, DavidThe social and economic consequences of poor mental health in the developing world are presumed to be significant, yet remain underresearched. This study uses data from nationally representative surveys in Bosnia and Herzegovina, Indonesia, and Mexico and from special surveys in India and Tonga to show similar patterns of association between mental health and socioeconomic characteristics. Individuals who are older, female, widowed, and report poor physical health are more likely to report worse mental health. Individuals living with others with poor mental health are also significantly more likely to report worse mental health themselves. In contrast, there is little observed relation between mental health and consumption poverty or education, two common measures of socioeconomic status. Indeed, the results here suggest instead that economic and multidimensional shocks, such as illness or crisis, can have a greater impact on mental health than poverty. This may have important implications for social protection policy. Also significant, the associations between poor mental health and lower labor force participation (especially for women) and more frequent visits to health centers suggest that poor mental health can have economic consequences for households and the health system. Mental health modules could usefully be added to multipurpose household surveys in developing countries. Finally, measures of mental health appear distinct from general subjective measures of welfare such as happiness.
Publication(World Bank, Washington, DC, 2005-07) Das, Jishnu ; Hammer, JeffreyThe quality of medical care received by patients varies for two reasons: differences in doctors' competence or differences in doctors' incentives. Using medical vignettes, the authors evaluated competence for a sample of doctors in Delhi. One month later, they observed the same doctors in their practice. The authors find three patterns in the data. First, what doctors do is less than what they know they should do-doctors operate well inside their knowledge frontier. Second, competence and effort are complementary so that doctors who know more also do more. Third, the gap between what doctors do and what they know responds to incentives: doctors in the fee-for-service private sector are closer in practice to their knowledge frontier than those in the fixed-salary public sector. Under-qualified private sector doctors, even though they know less, provide better care on average than their better-qualified counterparts in the public sector. These results indicate that to improve medical services, at least for poor people, there should be greater emphasis on changing the incentives of public providers rather than increasing provider competence through training.
Quality and Accountability in Healthcare Delivery: Audit Evidence from Primary Care Providers in India(World Bank, Washington, DC, 2015-06) Das, Jishnu ; Holla, Alaka ; Mohpal, Aakash ; Muralidharan, KarthikThis paper presents direct evidence on the quality of health care in low-income settings using a unique and original set of audit studies, where standardized patients were presented to a nearly representative sample of rural public and private primary care providers in the Indian state of Madhya Pradesh. Three main findings are reported. First, private providers are mostly unqualified, but they spent more time with patients and completed more items on a checklist of essential history and examination items than public providers, while being no different in their diagnostic and treatment accuracy. Second, the private practices of qualified public sector doctors were identified and the same doctors exerted higher effort and were more likely to provide correct treatment in their private practices. Third, there is a strong positive correlation between provider effort and prices charged in the private sector, whereas there is no correlation between effort and wages in the public sector. The results suggest that market-based accountability in the unregulated private sector may be providing better incentives for provider effort than administrative accountability in the public sector in this setting. While the overall quality of care is low both sectors, the differences in provider effort may partly explain the dominant market share of fee-charging private providers even in the presence of a system of free public healthcare.
Publication(World Bank, Washington, DC, 2016-02) Muralidharan, Karthik ; Das, Jishnu ; Holla, Alaka ; Mohpal, AakashThe relative return to input-augmentation versus inefficiency-reduction strategies for improving education system performance is a key open question for education policy in low-income countries. Using a new nationally-representative panel dataset of schools across 1297 villages in India, this paper shows that the large investments over the past decade have led to substantial improvements in input-based measures of school quality, but only a modest reduction in inefficiency as measured by teacher absence. In the data, 23.6 percent of teachers were absent during unannounced visits with an associated fiscal cost of $1.5 billion/year. There are two robust correlations in the nationally-representative panel data that corroborate findings from smaller-scale experiments. First, reductions in student-teacher ratios are correlated with increased teacher absence. Second, increases in the frequency of school monitoring are strongly correlated with lower teacher absence. Simulations using these results suggest that investing in better governance by increasing the frequency of monitoring could be over ten times more cost effective at increasing teacher-student contact time (net of teacher absence) than hiring more teachers. Thus, at current margins, policies that decrease the inefficiency of public spending in India are likely to yield substantially higher returns than those that augment inputs.
Publication( 2011-08-01) Das, Jishnu ; Hammer, Jeffrey ; Sánchez-Paramo, CarolinaBetween 2000 and 2002, the authors followed 1621 individuals in Delhi, India using a combination of weekly and monthly-recall health questionnaires. In 2008, they augmented these data with another 8 weeks of surveys during which households were experimentally allocated to surveys with different recall periods in the second half of the survey. This paper shows that the length of the recall period had a large impact on reported morbidity, doctor visits, time spent sick, whether at least one day of work/school was lost due to sickness, and the reported use of self-medication. The effects are more pronounced among the poor than the rich. In one example, differential recall effects across income groups reverse the sign of the gradient between doctor visits and per-capita expenditures such that the poor use health care providers more than the rich in the weekly recall surveys but less in monthly recall surveys. The authors hypothesize that illnesses -- especially among the poor -- are no longer perceived as "extraordinary events" but have become part of "normal" life. They discuss the implications of these results for health survey methodology, and the economic interpretation of sickness in poor populations.