Religious Discrimination in Health: Evidence from an Audit Study in Indonesia

Last registered on December 06, 2022

Pre-Trial

Trial Information

General Information

Title
Religious Discrimination in Health: Evidence from an Audit Study in Indonesia
RCT ID
AEARCTR-0010517
Initial registration date
November 30, 2022

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
November 30, 2022, 5:07 PM EST

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Last updated
December 06, 2022, 6:57 AM EST

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Region

Primary Investigator

Affiliation
University of Goettingen

Other Primary Investigator(s)

PI Affiliation
Universitas Indonesia
PI Affiliation
University of Goettingen

Additional Trial Information

Status
On going
Start date
2021-06-01
End date
2023-06-30
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
A vast literature in economics documents large differences in health outcomes by gender, race, wealth, and religion. To what extent these differences are driven by biases of health care providers is less understood. In this study, we explore whether health care providers discriminate against people with different religious beliefs using an audit study design (standardized patient method) on the clinical case of tuberculosis, an illness that is still widespread in Indonesia. The audit study is conducted in three provinces of Indonesia – Sumatera Barat, Sulawesi Utara and Jawa Tengah. The study covers 400 doctors at 400 randomly selected primary health care facilities in these three provinces. We conduct 1,600 standardized patient visits in which we vary the religious belief the patient. We complement the audit study with detailed facility- and doctor surveys in order to study the underlying nature of the observed biases.
External Link(s)

Registration Citation

Citation
Dartanto, Teguh, Renate Hartwig and Jan Priebe. 2022. "Religious Discrimination in Health: Evidence from an Audit Study in Indonesia." AEA RCT Registry. December 06. https://doi.org/10.1257/rct.10517-1.2
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Experimental Details

Interventions

Intervention(s)
We employ an audit study in which standardized patients (SP) of different religous beliefs portray a clinical case of tuberculosis to test if there is religious discriminiation by health care providers.
Intervention Start Date
2022-03-15
Intervention End Date
2023-02-28

Primary Outcomes

Primary Outcomes (end points)
I) Quality of care - (a) an indicator of obtaining a diagnosis (binary), (b), an indicator of obtaining the correct diagnosis (binary), (c) adherence to the correct checklist items (binary and count of essential anamneses and diagnostics) and (d) duration spent with the doctor (continuous).
II) Cost of treatment – cost of consultation (continuous).
Primary Outcomes (explanation)
We use four different measures of the quality of care. First, we measure the quality of care based on the diagnosis, i.e. if the provider provided a diagnosis and second and – more importantly – if the provider provided the correct diagnosis for the clinical case presented. Third, we measure the quality of care based on the quality of the medical consultation. We assess this by compiling information on the questions and examinations conducted (dummy and count variable). Fourth we also look at the time spent with the health professional as another metric of the quality of care.

Secondary Outcomes

Secondary Outcomes (end points)
Secondary outcomes include variables that we will use to investigate mechanisms through heterogeneous treatment effects. Secondary outcomes are related to three distinct features of the intervention: (a) patient characteristics such as religion/religiousness and wealth, (b) provider characteristics such as religion/religiousness, implicit attitudes and beliefs towards certain religions, wealth, social preferences, time preferences, tolerance, in-group favoritisms, competition, and (c) social norms at the community-level.
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
We employ an audit study in which standardized patients (SP) of different religous beliefs portray a clinical case of tuberculosis to test if there is religious discriminiation by health care providers.
Experimental Design Details
Not available
Randomization Method
The random assignment was done by PIs with a replicable procedure using statistical software.
Randomization Unit
The unit of randomization is the SP visit.
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
N.A.
Sample size: planned number of observations
We plan with a minimum sample of 400 primary health centers, across 3 provinces of Indonesia. At the health provider visit level, the total number of observations is 1,600 (4 standardized patient visits x 400 health care providers).
Sample size (or number of clusters) by treatment arms
We will assign 4 standardized patients to each health care provider. At the health provider visit level each treatment arms has 400 observations.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
In a basic group means comparison with 80% power, a significance level of 0.05, and unit standard deviations, the MDE is .09pp for the total sample of 1,600 standardized patient visits (Assumption: Baseline mean of 0.6 & 1 treatment vs. 1 control group comparison).
IRB

Institutional Review Boards (IRBs)

IRB Name
GIGA Ethics Committee
IRB Approval Date
2021-08-26
IRB Approval Number
06/2021
IRB Name
Atma Jaya Catholic University
IRB Approval Date
2022-04-01
IRB Approval Number
0003V/III/PPPE.PM.10.05/04/2022
Analysis Plan

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