What is the Quality of Care in a Developing Country? Measuring Physician Practice and Health Outcomes

Although it is widely believed that less-developed countries have lower standards of medical care than the developed world, there are few quantifiable measures of quality of clinical care in less-developed countries. The objectives of this dissertation are to provide a better understanding of how to measure quality of health care in a less-developed country, in an effort to furnish an instrument for improving clinical care and national health policy formulation. Its intended audience is health care policymakers and providers, specifically those ministering to the less-developed world. The research uses the standard framework for measuring quality of health care that is based on three measures of quality: structure, process, and outcome. Structural measures are relatively inexpensive to obtain and are readily available. The dissertation provides a direct measure of clinical process and analyzes its relationship with structural and outcome measures. It also provides empirical evidence of the effects of structural measures on process of care, and of the effects of medical knowledge on the health status of a population at the aggregate level. The research found that physicians' characteristics played a greater role in explaining the process of care than did equipment measures. For the outpatient conditions selected in this study, there is evidence to suggest that who the physicians are is a better indicator of the level of care they will provide than where they practice. The process of care, in turn, is related to health status in the population, the ultimate mark of any health policy intervention. It is thus advisable that policymakers seeking to improve a health system's performance should try to explore interventions that target the process of care.