The primary aim of this study is to identify the discrimination faced by individuals based on their caste and religion. In India, caste and religion are usually gleaned by one's name and when applicable, by the way in which one presents oneself. As such, we designed an intervention that induces random variation in these attributes. We randomly vary SP roles across providers to estimate the effect of caste and religion of the patient on the healthcare they receive.
Each provider received a visit from one of four different SP types. Each SP type introduced themselves by name before the visit begins in order to signal their religion or caste. Type-1 SPs had an upper-caste Hindu name and were dressed in a well-ironed shirt and trousers. They introduced themselves by saying "Namaste" (the Hindi salutation most commonly used by Hindus in India). Type-2 SPs had a Muslim name and were also dressed in a well ironed shirt and trousers. Type-3 SPs also had a Muslim name (the same as Type-2) but they presented with certain religious indicators such as skull cap, a beard, and were wearing a kurta-pyjama. Both Type-2 and Type-3 SPs introduced themselves by saying Salaam (the Urdu salutation most commonly used by Muslims in India) Type-4 SPs had a Dalit name and were dressed in a more unkempt manner than the other SPs. This was only because, in the Indian context, caste is often (but not always) very closely correlated with class. Instead, caste is usually only displayed by physical religious indicators by those of the upper-castes (and even then, it is uncommon in most cities). Type-4 SPs also introduce themselves by saying Namaste.
Ten unique enumerators were selected from a larger pool of 16 actors to play the SP roles. Of the ten enumerators, five were Muslims and five were Hindu. The Muslim enumerators played both muslim roles while the Hindu enumerators played both Hindu roles but the Muslim enumerators did not play either Hindu role and vice versa. This was done to ensure the safety of the enumerators since religion and caste are very sensitive issues in India and if an enumerator was caught pretending to be someone of a different caste or religion, they may be mistreated. All the SPs presented with an identical case of asthma. This case of asthma was adapted from the cases developed by ISERDD in New Delhi (Institute for Socio-Economic Research on Development and Democracy) for the Quality of Tuberculosis Care (Qutub) Project. They were trained extensively over the week long training period. so that each role
was portrayed consistently across actors. This included memorizing answers to common questions
(e.g., “when did you last feel breathless?”, ”how long does an episode of breathlessness last?”, or “what were you doing when you last felt breathless?”) so that each
actor responds similarly for the respective role. We randomly assigned the SP role the providers receive (stratified by town) and further, randomly assigned the actors to play each role (within the Muslim and Hindu pools of enumerators). All SPs completed the visit and pay any fees required by the doctor. The standardized nature of the cases presented to the providers helps isolate the effect of the caste and religion (and visibility of religion) on healthcare delivery.