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Dzampe AK, Takahashi S. Competition and quality of care under regulated fees: evidence from Ghana. HEALTH ECONOMICS REVIEW 2022; 12:57. [PMID: 36355234 PMCID: PMC9647994 DOI: 10.1186/s13561-022-00406-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND How competition affects the quality of care is still not well understood empirically because of limited and mixed results. This study examined whether competition leads to higher or lower quality health outcomes in Ghana. METHODS We used administrative claims data of hypertension patients for 2017 - 2019 (36 months), and an instrumental variable method to examine the effect of competition, measured as an increase in district doctor-to-population ratio on hospital-level ambulatory care sensitive condition hospitalization and in-hospital death rates. RESULTS Overall, we found that an increase in doctor density improves the quality of care for hypertension patients in Ghana. That is, when there are more doctors, fewer patients are hospitalized, and the risk of in-hospital deaths decreases. This result is robust to analyses at the individual and district population levels for ambulatory care sensitive hospitalizations rate. CONCLUSIONS Our findings suggest that in the presence of physician-induced demand, competition can lead to improvement in the quality of care, possibly through improved access to healthcare and increased physician time and contact per patient. Future health policies need to consider possible welfare benefits of induced medical services and training more doctors.
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Affiliation(s)
- Adolf Kwadzo Dzampe
- Japan Development Service (JDS) PhD Fellow, Graduate School for International Development and Cooperation, Hiroshima University, 1-5-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8529 Japan
- Claims Processing Centre, National Health Insurance Authority, PMB Ministries, Accra, Ghana
| | - Shingo Takahashi
- Associate Professor, Graduate School for International Development and Cooperation, Hiroshima University, 1-5-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8529 Japan
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Dzampe AK, Takahashi S. Competition and physician-induced demand in a healthcare market with regulated price: evidence from Ghana. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2022; 22:295-313. [PMID: 34919181 PMCID: PMC9365740 DOI: 10.1007/s10754-021-09320-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/05/2021] [Indexed: 05/31/2023]
Abstract
Using panel data of administrative claims spanning 36 months (2017-2019) and an instrumental variable method, this study examines whether physician-induced demand for hypertension disease care exists in Ghana's healthcare system where price is regulated, and there is no co-payment. We find that an increase in competition-measured as a high doctor-to-population ratio at the district level-leads to an increase in the number of physician visits, suggesting physician-induced demand exists, and that effects are greater for large hospitals and public health providers. This result is further supported by alternative measures and specifications showing that physicians' revenue from medication and gross revenue increase as the physician density increases. These pattern suggest that physicians in high density areas, faced with a decrease in number of patients per physician, make up for the decline in income by inducing more patient visits.
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Affiliation(s)
- Adolf Kwadzo Dzampe
- Graduate School for International Development and Cooperation, Hiroshima University, 1-5-1 Kagamiyama, Higashi-Hiroshima, 739-8529 Japan
| | - Shingo Takahashi
- Graduate School for International Development and Cooperation, Hiroshima University, 1-5-1 Kagamiyama, Higashi-Hiroshima, 739-8529 Japan
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Liu H, Xu X, Liu D, Rao Y, Reis C, Sharma M, Yuan J, Chen Y, Zhao Y. Nutrition-Related Knowledge, Attitudes, and Practices (KAP) among Kindergarten Teachers in Chongqing, China: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040615. [PMID: 29597273 PMCID: PMC5923657 DOI: 10.3390/ijerph15040615] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 03/19/2018] [Accepted: 03/23/2018] [Indexed: 12/02/2022]
Abstract
Kindergarten teachers play an important role in providing kindergarten children with education on nutrition. However, few studies have been published on nutrition-related knowledge, attitudes, and practices (KAP) of Chinese kindergarten teachers. This study aimed to assess the nutrition-related knowledge, attitudes, and practices (KAP) of kindergarten teachers in Chongqing, China. Thus, a cross-sectional survey was conducted using a structured KAP model questionnaire administered to 222 kindergarten teachers, who were senior teachers from 80 kindergartens in 19 districts and 20 counties in Chongqing. Multiple regression analysis was used to analyze the influential factors. Among the participants, 54.2% were familiar with simple nutrition-related knowledge; only 9.9% of them were satisfied with their knowledge of childhood nutrition; and 97.7% of them had a positive attitude to learn nutrition-related knowledge. Only 38.7% of the participants had attended pediatric nutrition knowledge courses or training. Multiple regression analysis confirmed significant independent effects on the nutrition knowledge score (p < 0.0001) of respondents on age, type of residence, type of kindergarten, body mass index(BMI), professional training of kindergarten teachers, behavior of having ever participated in childhood nutrition education knowledge courses or training, and behavior of having ever paid attention to children’s nutrition knowledge. The model indicated that independent variables explained 45.4% (adjusted R2) of the variance found in the knowledge scores of respondents. While there were low levels of nutrition knowledge and training, it was still encouraging to note that there were positive attitudes towards acquiring nutrition-related knowledge among kindergarten teachers in Chongqing, China. These findings provide some implications that necessary training measures need to be carried out to improve the nutrition-related knowledge level among kindergarten teachers in China.
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Affiliation(s)
- Hongyan Liu
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Xianglong Xu
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Dengyuan Liu
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Yunshuang Rao
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Cesar Reis
- Preventive Medicine Department, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - Manoj Sharma
- Behavioral & Environmental Health, School of Public Health, Jackson State University, 350 West Woodrow Wilson Avenue, Jackson, MS 39213, USA.
- Health Sciences, Walden University, 100 Washington Avenue South, Suite 900, Minneapolis, MN 55401, USA.
| | - Jun Yuan
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Yao Chen
- Medical Examination Center, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
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