آیا رضایت بیمار در کیفیت مراقبت حساسیتی ایجاد می کند؟بهره برداری از اثر هاتورن

We introduce a new instrument to evaluate the impact of behavior on outcomes when the behavior may be a function of unobserved variables that also affect outcomes. The instrument is introduced through a test of patient sensitivity to increases in the quality of care provided by doctors. We utilize the Hawthorne effect, in which the very presence of a research team causes doctors to provide measurably superior quality care for any type of patient to show that patients respond to this increased quality and are more likely to be very satisfied. Using the Hawthorne effect as an instrument allows us to examine the responsiveness of satisfaction to improvements in quality despite the fact that patient satisfaction is subjective and jointly produced with quality during the course of a consultation.

In this paper, we ask “can patients in Arusha region of Tanzania recognize improved doctor adherence to medical protocol (quality)?” By examining a situation in which the presence of a research team causes increases in quality that are independent of patient and illness characteristics, we show that patients are significantly more likely to be very satisfied with the quality of care they receive when the doctor provides better care than he usually does. Patient do, in fact, recognize and value quality care. A 1% increase in protocol adherence (from an average adherence of about 53%) is associated with about a 0.40% increase in the probability that a patient will declare the consultation to have been “very good” (from an average level of about 12%). As a check on the source of responsiveness in satisfaction, we examine the responsiveness of satisfaction to the duration of the consultation and do not find evidence that patients respond to this measure of inputs. This evidence of sensitivity to quality suggests that patients’ beliefs about quality may be responsive to their experiences, particularly when they witness significant changes in quality. It does not prove that patients can use their knowledge to alter the quality of care they receive during the actual consultation. However, though we have no reason to believe that the patients we interviewed plan to change their behavior immediately, their sensitivity to quality suggests that if quality changed permanently, they might eventually change their behavior. Indeed, Leonard et al. (2002) and Leonard (2007) show that patients in Tanzania use their beliefs about quality to choose which doctor to visit and whether to seek care. Thus, even if this sensitivity to quality is inadequate to ensure quality, it can create a secondary benefit to any program that increases doctor quality. Any program or policy that improves the quality of one doctor will benefit those patients who had already chosen to visit the doctor, those patients who decide to switch to that doctor because they hear that the doctor is better, and those patients who decide to make more frequent use of health care altogether because they have had more positive experiences.