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Can Patients' Reports Improve Health Providers' Performance?
Last registered on May 12, 2017

Pre-Trial

Trial Information
General Information
Title
Can Patients' Reports Improve Health Providers' Performance?
RCT ID
AEARCTR-0001844
Initial registration date
May 11, 2017
Last updated
May 12, 2017 11:14 AM EDT
Location(s)
Region
Primary Investigator
Affiliation
University of Virginia
Other Primary Investigator(s)
PI Affiliation
Southern Methodist University
Additional Trial Information
Status
Completed
Start date
2013-08-01
End date
2016-11-30
Secondary IDs
Abstract
We assess the effectiveness of accountability systems relying on patient reporting in the Kenyan health sector. We evaluate patients' willingness to file complaints on service providers, and providers' responsiveness to the possibility of receiving such complaints. We contrast reporting systems where complaints have no direct consequences on providers, such as standard complaint boxes, and reporting systems where complaints lead to either monetary penalties or non-monetary consequences, in the form of peer shaming. We employ a specially designed laboratory-in-the-field experiment involving randomly selected providers and patients from public and private health centers in Nairobi. We find that: 1) disclosing patients' complaints to providers' Health services, bottom-up accountability, patient reporting, peer shaming.professional peers is equally or more effective than imposing monetary penalties based on patients' complaints; 2) the possibility of retaliation against patients does not annul the effectiveness of reporting systems relying on peer shaming; 3) associating tangible consequences to complaints slightly lowers patients' willingness to file such complaints, mainly due to the existence of personal relationships with providers. Overall, our findings support the implementation of citizen reporting systems that leverage peer pressure and reputational concerns.
External Link(s)
Registration Citation
Citation
Mbiti, Isaac and Danila Serra. 2017. "Can Patients' Reports Improve Health Providers' Performance? ." AEA RCT Registry. May 12. https://doi.org/10.1257/rct.1844-1.0.
Former Citation
Mbiti, Isaac and Danila Serra. 2017. "Can Patients' Reports Improve Health Providers' Performance? ." AEA RCT Registry. May 12. https://www.socialscienceregistry.org/trials/1844/history/17580.
Experimental Details
Interventions
Intervention(s)
In the Reporting Game, patient/provider pairs are randomly assigned to one of four treatment groups in which researchers manipulate the costs and incentives associated with patient complaints.

Complaint box: Complaints are private, and only shown to the provider who is complained about (no cost).

Monetary penalty: Providers face a monetary penalty if they receive a complaint.

Peer disclosure: Complaints about particular providers are shown to all providers in the workshop - imposing a social cost.

Peer disclosure with retaliation: Similar to the simple peer disclosure treatment, but providers also have the option to impose a retaliation penalty against the patient who complained about them.
Intervention Start Date
2013-08-01
Intervention End Date
2013-12-31
Primary Outcomes
Primary Outcomes (end points)
patients' trusting decisions, amount sent by patients in the trust game, providers' responsiveness to different reporting systems, amount returned by providers in the trust game, willingness to complain, intensity of complaints
Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
Researchers conduct a lab-in-the-field experiment using a version of a standard trust game with patients and healthcare providers. In the "Reporting Game" patients are paired with health-workers, and patients must trust the provider; simulating the clinical interaction that generally occurs in the field. Patients can send money to providers and providers must decide how much of the tripled amount sent they want to return to the patient. Patients are then given the chance to file complaints against their matched provider on the basis of the money they receive back. The amount of money that providers send back to patients acts as a primary measure of health-worker behavior. A patient's decision to file a complaint, as a function of the amount returned by the provider, is the main measure of the patient's willingness to use participatory reporting systems.
Experimental Design Details
Randomization Method
As patients and providers arrived at the experimental workshops, they were invited to pick a badge with a green (providers) or an orange (patients) color and a number (1 to 5 for providers and 1 to 10 for patients).
Randomization Unit
Workshop
Was the treatment clustered?
Yes
Experiment Characteristics
Sample size: planned number of clusters
24 workshops
Sample size: planned number of observations
319 individuals (103 patients, 216 providers)
Sample size (or number of clusters) by treatment arms
Complaint box: 5 workshops (24 providers, 50 patients)
Monetary penalties: 6 workshops (26 providers, 52 patients)
Peer disclosure: 7 workshops (27 providers, 58 patients)
Peer disclosure with retaliation: 6 workshops (27 providers, 56 patients)
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
Southern Methodist University
IRB Approval Date
Details not available
IRB Approval Number
Details not available
Post-Trial
Post Trial Information
Study Withdrawal
Intervention
Is the intervention completed?
Yes
Intervention Completion Date
December 31, 2013, 12:00 AM +00:00
Is data collection complete?
Yes
Data Collection Completion Date
December 31, 2013, 12:00 AM +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
24 workshops
Was attrition correlated with treatment status?
Final Sample Size: Total Number of Observations
319 individuals
Final Sample Size (or Number of Clusters) by Treatment Arms
Data Publication
Data Publication
Is public data available?
No
Program Files
Program Files
Reports and Papers
Preliminary Reports
Relevant Papers
Abstract
We assess the effectiveness of accountability systems relying on patient reporting in the Kenyan health sector. We evaluate patients’ willingness to file complaints on service providers, and providers’ responsiveness to the possibility of receiving such complaints. We contrast reporting systems where complaints have no direct consequences on providers, such as standard complaint boxes, and reporting systems where complaints lead to either monetary penalties or non-monetary consequences in the form of peer shaming. We employ a specially designed laboratory-in-the-field experiment involving randomly selected providers and patients from public and private health centers in Nairobi. Combining the experimental variation with non-experimental variation in provider and client characteristics such as sector of work and the existence of personal relationships between clients and providers, we find that: 1) disclosing patients’ complaints to providers’ professional peers is at least as effective as imposing monetary penalties based on patients’ complaints; 2) the possibility of retaliation against patients does not reduce the effectiveness of reporting systems relying on peer shaming; 3) associating tangible consequences with complaints slightly lowers patients’ willingness to file such complaints, mainly due to the existence of personal relationships with providers. Overall, our findings support the implementation of citizen reporting systems that leverage peer pressure and reputational concerns.
Citation
Mbiti, Isaac, and Danila Serra. "Can Patients’ Reports Improve Health Providers’ Performance? Experimental Evidence from Kenya." Working Paper, March 2017.
Abstract
Can Patients' Reports Improve Health Providers' Performance? Experimental Evidence from Kenya - Working Paper, November 2016
Citation
Mbiti, Isaac, and Danila Serra. "Can Patients' Reports Improve Health Providers' Performance? Experimental Evidence from Kenya." Working Paper, November 2016.