Can Patients' Reports Improve Health Providers' Performance?

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.

2013-08-01

2013-12-31

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

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.

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).

Workshop

Yes

24 workshops

319 individuals (103 patients, 216 providers)

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)

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.

Mbiti, Isaac, and Danila Serra. "Can Patients’ Reports Improve Health Providers’ Performance? Experimental Evidence from Kenya." Working Paper, March 2017.

https://www.povertyactionlab.org/sites/default/files/publications/5072_Can-Patients_Reports-Improve-Health-Providers-Performance_MbitiSerra29_March2017.pdf

Can Patients' Reports Improve Health Providers' Performance? Experimental Evidence from Kenya - Working Paper, November 2016

Mbiti, Isaac, and Danila Serra. "Can Patients' Reports Improve Health Providers' Performance? Experimental Evidence from Kenya." Working Paper, November 2016.

https://faculty.smu.edu/dserra/KenyaPaper_MbitiSerra.pdf