Publication: Do Patients Value High-Quality Medical Care? Experimental Evidence from Malaria Diagnosis and Treatment
Loading...
Date
2024-04-05
ISSN
Published
2024-04-05
Author(s)
Editor(s)
Abstract
Can better information on the value of diagnostic tests improve adoption and help patients recognize higher quality of care? In a randomized experiment in public clinics in Mali, providers and patients received tailored information about the importance of rapid diagnostic tests (RDT) for malaria. The provider training increased reliance on RDTs and improved the match between a patient’s malaria status and treatment with antimalarials by 15–30 percent. Nonetheless, patients were significantly less satisfied with the care they received, driven by those whose prior beliefs did not match their malaria status. The patient information intervention reduced malaria testing and did not improve treatment outcomes or patient satisfaction. These findings are consistent with highly persistent patient beliefs and distrust of the promoted diagnostic technology, which translate into low demand and limit patients’ ability to recognize improved quality of care.
Link to Data Set
Citation
“Lopez, Carolina; Sautmann, Anja; Schaner, Simone. 2024. Do Patients Value High-Quality Medical Care? Experimental Evidence from Malaria Diagnosis and Treatment. Policy Research Working Paper; 10746. © World Bank. http://hdl.handle.net/10986/41375 License: CC BY 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Publication The Macroeconomic Implications of Climate Change Impacts and Adaptation Options(Washington, DC: World Bank, 2025-05-29)Estimating the macroeconomic implications of climate change impacts and adaptation options is a topic of intense research. This paper presents a framework in the World Bank's macrostructural model to assess climate-related damages. This approach has been used in many Country Climate and Development Reports, a World Bank diagnostic that identifies priorities to ensure continued development in spite of climate change and climate policy objectives. The methodology captures a set of impact channels through which climate change affects the economy by (1) connecting a set of biophysical models to the macroeconomic model and (2) exploring a set of development and climate scenarios. The paper summarizes the results for five countries, highlighting the sources and magnitudes of their vulnerability --- with estimated gross domestic product losses in 2050 exceeding 10 percent of gross domestic product in some countries and scenarios, although only a small set of impact channels is included. The paper also presents estimates of the macroeconomic gains from sector-level adaptation interventions, considering their upfront costs and avoided climate impacts and finding significant net gross domestic product gains from adaptation opportunities identified in the Country Climate and Development Reports. Finally, the paper discusses the limits of current modeling approaches, and their complementarity with empirical approaches based on historical data series. The integrated modeling approach proposed in this paper can inform policymakers as they make proactive decisions on climate change adaptation and resilience.Publication From Patriarchy to Policy(Washington, DC: World Bank, 2025-05-29)Legal institutions play an important role in shaping gender equality in economic domains, from inheritance to labor markets. But where do gender equal laws come from? Using cross-country data on social norms and legal equality, this paper investigates the socio-cultural roots of gender inequity in the legal system and its implications for female labor force participation. To identify the impact of social norms, the analysis uses an empirical strategy that exploits pre-modern differences in ancestral patriarchal culture as an instrument for present-day gender norms. The findings show that ancestral patriarchal culture is a strong predictor of contemporary norms, and conservative social norms are associated with more gender inequality in the de jure legal framework, the de facto implementation of laws, and the labor market. The paper presents evidence for a political selection mechanism linking norms to laws: countries with more conservative norms elect political leaders who are more hostile to gender equality, who then pass less progressive legislation. The results highlight the cultural roots and political drivers of legalized gender inequality.Publication Geopolitics and the World Trading System(Washington, DC: World Bank, 2024-12-23)Until the beginning of this century, the GATT/WTO system worked. Economic research provided a compelling explanation. It showed that if governments maximize the well-being of their own countries broadly defined, GATT/WTO principles would facilitate mutually beneficial cooperation over their trade policy choices. Now heightened geopolitical rivalry seems to have undermined the WTO. A simple transposition of the previous rationalization suggests that geopolitics and trade cooperation are not compatible. The paper shows that this is only true if rivalry eclipses any consideration of own-country well-being. In all other circumstances, there are gains from trade cooperation even with geopolitics. Furthermore, the WTO’s relevance is in question only if it adheres too rigidly to its existing rules and norms. Through measured adaptation to the geopolitical imperative, the WTO can continue to thrive as a forum for multilateral trade cooperation in the age of geopolitics.Publication Rethinking Fiscal Policies(Washington, DC: World Bank, 2025-05-27)This paper examines the redistributive impact of fiscal policy—specifically taxes and transfers—on poverty and inequality in eight countries in the Middle East and North Africa: the Arab Republic of Egypt, Djibouti, the Islamic Republic of Iran, Iraq, Jordan, Morocco, Tunisia, and the West Bank and Gaza. Utilizing the Commitment to Equity framework, the analysis evaluates how fiscal interventions alter income distribution across these diverse national contexts. The results indicate that direct cash transfers and social assistance programs are generally effective in reducing poverty and shielding vulnerable populations, while in-kind benefits—particularly in education and healthcare—significantly contribute to mitigating income inequality. In contrast, generalized subsidies, especially in the energy sector, are fiscally burdensome and largely regressive, offering limited equity gains. Indirect taxes, although important for revenue generation, often exacerbate income disparities. The study underscores the need for comprehensive fiscal reforms, including the expansion of well-targeted transfers, adoption of progressive taxation, and reallocation of inefficient subsidies toward investments in human capital. Successful initiatives, such as Egypt’s Takaful and Karama and Jordan’s Takaful and bread subsidy compensation programs, illustrate scalable models of effective redistribution. Moreover, the Islamic Republic of Iran’s progressive tax policies highlight viable pathways to equitable revenue mobilization. Strengthening investment in education and health is essential for promoting long-term equity, enhancing upward mobility, and supporting inclusive and sustainable development across the region.Publication Yield Gains from Balancing Fertilizer Use(Washington, DC: World Bank, 2025-05-29)As with most agricultural inputs, the optimal use of fertilizer leverages the production complementarities between different types of nutrients. Wide variation in the intensity of nutrient application rates suggests there are potentially large productivity gains to be had from rebalancing fertilizer use across nutrient types even under a fixed expenditure budget. Using detailed information on a large sample of rice fields across three states in eastern India, this paper investigates whether a more balanced use of fertilizer—measured as the ratio of potash to nitrogen applied to a field—can lead to higher yields and revenues. To address the endogeneity of fertilizer application decisions, the analysis exploits the fact that nitrogen-based fertilizers demanded by Indian farmers are mostly produced domestically in a limited number of manufacturing plants, while all potash-based fertilizers must be imported by ship from abroad. Instrumenting for the ratio of potassium-to-nitrogen fertilizer applied on a field with the relative travel distances between farmers’ villages and both the nearest urea production plant and the nearest international port, the paper estimates the impact of more balanced fertilizer use on yields and revenues. The estimates show that at median levels of fertilizer use, and keeping the level of expenditure on fertilizers constant, rebalancing fertilizer application choices such that the potassium-to-nitrogen ratio of fertilizer is doubled would lead to a 4.8 percent increase in yield.
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Does Patient Demand Contribute to the Overuse of Prescription Drugs?(World Bank, Washington, DC, 2020-11)This study conducted an experiment in Mali to test whether patients pressure doctors to prescribe medical treatment they do not necessarily need. The experiment varied patients’ information about a discount for antimalarial tablets and measured demand for both tablets and costlier antimalarial injections. The study finds evidence of patient-driven demand: informing patients about the discount, instead of letting doctors decide to share this information, increased discount use by 35 percent and overall malaria treatment by 10 percent. These marginal patients rarely had malaria, worsening the illness-treatment match. Providers did not use the information advantage to sell injections -- their use fell in both information conditions.Publication Health Information, Treatment, and Worker Productivity : Experimental Evidence from Malaria Testing and Treatment among Nigerian Sugarcane Cutters(World Bank Group, Washington, DC, 2014-11)Agricultural and other physically demanding sectors are important sources of growth in developing countries but prevalent diseases such as malaria adversely impact the productivity, labor supply, and choice of job tasks among workers by reducing physical capacity. This study identifies the impact of malaria on worker earnings, labor supply, and daily productivity by randomizing the temporal order at which piece-rate workers at a large sugarcane plantation in Nigeria are offered malaria testing and treatment. The results indicate a significant and substantial intent to treat effect of the intervention -- the offer of a workplace-based malaria testing and treatment program increases worker earnings by approximately 10 percent over the weeks following the offer. The study further investigates the effect of health information by contrasting program effects by workers' revealed health status. For workers who test positive for malaria, the treatment of illness increases labor supply, leading to higher earnings. For workers who test negative, and especially for those workers most likely to be surprised by the healthy diagnosis, the health information also leads to increased earnings via increased productivity. Possible mechanisms for this response include selection into higher return tasks within the plantation as a result of changes in the perceived cost of effort. A model of the worker labor decision that allows health expectations partly to determine the supply of effort suggests that, in endemic settings with poor quality health services, inaccurate health perceptions may lead workers to suboptimal labor allocation decisions. The results underline the importance of medical treatment, but also of access to improved information about one's health status, as the absence of either may lead workers to deliver lower effort in lower return jobs.Publication Establishing Private Health Care Facilities in Developing Countries : A Guide for Medical Entrepreneurs(2007)This book is a practical guide for medical professionals who are interested in establishing health care facilities in developing countries. It is intended for individuals and organizations with little or no business experience who are seeking guidance on how to turn a general idea into concrete reality. The author's goals in writing the book were modest. The guide does not provide an exact roadmap for building a hospital or other type of health care facility, nor is there any guarantee that the new entrepreneur who follows the approach described will be able to obtain financing from investors. Rather, the book is designed as an introductory resource with which to begin the process.Publication The Quality of Medical Advice in Low-Income Countries(World Bank, Washington, DC, 2008-01)This paper provides an overview of recent work on quality measurement of medical care and its correlates in four low and middle-income countries-India, Indonesia, Tanzania, and Paraguay. The authors describe two methods-testing doctors and watching doctors-that are relatively easy to implement and yield important insights about the nature of medical care in these countries. The paper discusses the properties of these measures, their correlates, and how they may be used to evaluate policy changes. Finally, the authors outline an agenda for further research and measurement.Publication The Use of Placebo in a Trial of Rectal Artesunate as Initial Treatment for Severe Malaria Patients En Route to Referral Clinics : Ethical Issues(2010)Placebo-controlled trials are controversial when individuals might be denied existing beneficial medical interventions. In the case of malaria, most patients die in rural villages without healthcare facilities. An artesunate suppository that can be given by minimally skilled persons might be of value when patients suddenly become too ill for oral treatment but are several hours from a facility that can give injectable treatment for severe disease. In such situations, by default, no treatment is (or can be) given until the patient reaches a facility, making the placebo control design clinically relevant; alternative bioequivalence designs at the facility would misrepresent reality and risk incorrect conclusions. We describe the ethical issues underpinning a placebo-controlled trial in severe malaria. To protect patients and minimise risk, all patients were referred immediately to hospital so that each had a higher chance of prompt treatment through participation. There was no difference between artesunate and placebo in patients who reached clinic rapidly; among those who could not, a single artesunate suppository significantly reduced death or permanent disability, a finding of direct and indirect benefit to patients in participating villages and elsewhere.
Users also downloaded
Showing related downloaded files
Publication Economic Recovery(World Bank, Washington, DC, 2021-04-06)World Bank Group President David Malpass spoke about the world facing major challenges, including COVID, climate change, rising poverty and inequality and growing fragility and violence in many countries. He highlighted vaccines, working closely with Gavi, WHO, and UNICEF, the World Bank has conducted over one hundred capacity assessments, many even more before vaccines were available. The World Bank Group worked to achieve a debt service suspension initiative and increased transparency in debt contracts at developing countries. The World Bank Group is finalizing a new climate change action plan, which includes a big step up in financing, building on their record climate financing over the past two years. He noted big challenges to bring all together to achieve GRID: green, resilient, and inclusive development. Janet Yellen, U.S. Secretary of the Treasury, mentioned focusing on vulnerable people during the pandemic. Kristalina Georgieva, Managing Director of the International Monetary Fund, focused on giving everyone a fair shot during a sustainable recovery. All three commented on the importance of tackling climate change.Publication Education, Social Norms, and the Marriage Penalty(Washington, DC: World Bank, 2024-10-16)A growing literature attributes gender inequality in labor market outcomes in part to the reduction in female labor supply after childbirth, the child penalty. However, if social norms constrain married women’s activities outside the home, then marriage can independently reduce employment, even in the absence childbearing. Given the correlation in timing between childbirth and marriage, conventional estimates of child penalties will conflate these two effects. The paper studies the marriage penalty in South Asia, a context featuring conservative gender norms and low female labor force participation. The study introduces a split-sample, pseudo-panel approach that allows for the separation of marriage and child penalties even in the absence of individual-level panel data. Marriage reduces women’s labor force participation in South Asia by 12 percentage points, whereas the marginal penalty of childbearing is small. Consistent with the central roles of both opportunity costs and social norms, the marriage penalty is smaller among cohorts with higher education and less conservative gender attitudes.Publication Media and Messages for Nutrition and Health(World Bank, Washington, DC, 2020-06)The Lao People’s Democratic Republic (Lao PDR) has experienced rapid and significant economic growth over the past decade. However, poor nutritional outcomes remain a concern. Rates of childhood undernutrition are particularly high in remote, rural, and upland areas. Media have the potential to play an important role in shaping health and nutrition–related behaviors and practices as well as in promoting sociocultural and economic development that might contribute to improved nutritional outcomes. This report presents the results of a media audit (MA) that was conducted to inform the development and production of mass media advocacy and communication strategies and materials with a focus on maternal and child health and nutrition that would reach the most people from the poorest communities in northern Lao PDR. Making more people aware of useful information, essential services and products and influencing them to use these effectively is the ultimate goal of mass media campaigns, and the MA measures the potential effectiveness of media efforts to reach this goal. The effectiveness of communication channels to deliver health and nutrition messages to target beneficiaries to ensure maximum reach and uptake can be viewed in terms of preferences, satisfaction, and trust. Overall, the four most accessed media channels for receiving information among communities in the study areas were village announcements, mobile phones, television, and out-of-home (OOH) media. Of the accessed media channels, the top three most preferred channels were village announcements (40 percent), television (26 percent), and mobile phones (19 percent). In terms of trust, village announcements were the most trusted source of information (64 percent), followed by mobile phones (14 percent) and television (11 percent). Hence of all the media channels, village announcements are the most preferred, have the most satisfied users, and are the most trusted source of information in study communities from four provinces in Lao PDR with some of the highest burden of childhood undernutrition.Publication South Asia Development Update, April 2024: Jobs for Resilience(Washington, DC: World Bank, 2024-04-02)South Asia is expected to continue to be the fastest-growing emerging market and developing economy (EMDE) region over the next two years. This is largely thanks to robust growth in India, but growth is also expected to pick up in most other South Asian economies. However, growth in the near-term is more reliant on the public sector than elsewhere, whereas private investment, in particular, continues to be weak. Efforts to rein in elevated debt, borrowing costs, and fiscal deficits may eventually weigh on growth and limit governments' ability to respond to increasingly frequent climate shocks. Yet, the provision of public goods is among the most effective strategies for climate adaptation. This is especially the case for households and farms, which tend to rely on shifting their efforts to non-agricultural jobs. These strategies are less effective forms of climate adaptation, in part because opportunities to move out of agriculture are limited by the region’s below-average employment ratios in the non-agricultural sector and for women. Because employment growth is falling short of working-age population growth, the region fails to fully capitalize on its demographic dividend. Vibrant, competitive firms are key to unlocking the demographic dividend, robust private investment, and workers’ ability to move out of agriculture. A range of policies could spur firm growth, including improved business climates and institutions, the removal of financial sector restrictions, and greater openness to trade and capital flows.Publication Remarks at the United Nations Biodiversity Conference(World Bank, Washington, DC, 2021-10-12)World Bank Group President David Malpass discussed biodiversity and climate change being closely interlinked, with terrestrial and marine ecosystems serving as critically important carbon sinks. At the same time climate change acts as a direct driver of biodiversity and ecosystem services loss. The World Bank has financed biodiversity conservation around the world, including over 116 million hectares of Marine and Coastal Protected Areas, 10 million hectares of Terrestrial Protected Areas, and over 300 protected habitats, biological buffer zones and reserves. The COVID pandemic, biodiversity loss, climate change are all reminders of how connected we are. The recovery from this pandemic is an opportunity to put in place more effective policies, institutions, and resources to address biodiversity loss.