Out recently is an interesting AEA paper by Okeke 2023, who examines a policy experiment by the Nigerian government that aimed determine whether expand access to physicians improved health outcomes.
In this experiment, some communities were randomly selected to receive a new doctor. These doctors were posted to the local public health center. Prior to their arrival, health care was provided by midlevel health-care providers (MLP). To separate the effect of (ostensibly higher) quality from that of quantity, another group of communities was provided with an additional midlevel provider. A third group of communities received no additional workers. No other inputs were provided. I find a measurable decrease in mortality in communities assigned a doctor but not in communities assigned an MLP, suggesting that quality in the health-care sector is a significant constraint.
The specific findings include:
…in communities where a doctor was assigned, the probability that care during pregnancy was provided by a doctor increased by about 22 percentage points…
early infant mortality…decreased by about 20 percent. For context, a 20 percent decrease in mortality would, all but, eliminate the existing mortality gap between rural and urban areas in Nigeria
How did physicians achieve this? The author notes that doctors were “…more likely to follow recommended clinical guidelines, more likely to carry out a physical examination, and more likely to reach a diagnosis.” Physician communication skills were also noted to be superior as compared to mid-level providers.
The full paper is here.