What happens when managers of private health care clinics are trained on how to run more professional businesses? Evidence from a large-scale randomized experiment in Kenya (with Paul J. Gertler and Ada Kwan)

My job market paper studies the effects of a large-scale consulting intervention that sought to improve health market outcomes in Kenyan private clinics. The experimental intervention featured business improvement, quality of care accreditation, and social franchising. We measured quality of care using the gold standard – Standardized Patients, complemented with clinic, medical provider, and household survey data.

We explore the mediating effect of a) medical provider preferences and b) management adoption on measures of quality, prices, and profitability. We find that the intervention improved the scale, profitability, and efficiency of care delivery, but quality of care decreased (as measured by correct case management) and prices increased. Clients did not seem to notice the drop in quality of care. We also show that the effect on quality and prices was concentrated among the group of clinics with pure profit-oriented preferences, while the program had no effect on altruistic providers.

The results from our research are key to improve the viability of public-private arrangements to provide universal healthcare access. First, we provide evidence about the role of management for primary healthcare in private markets in low- and middle-income countries. Second, we show that management training is able to alter clinicians' social preferences by making them more profit-oriented, which in turn reduces correct case management and increases the price of health services.  Third, we show quantitative results about the efficiency-quality trade-off that is pervasive in healthcare and other service industries with differentiated products with endogenous quality, where more accountability and oversight mechanisms are needed to guarantee minimum levels of quality of care.

Dissertation committee:

• Paul Gertler, PhD, (Chair), Haas School of Business, University of California, Berkeley
• Stefano Bertozzi, MD PhD, School of Public Health, University of California, Berkeley
• Ziad Obermeyer, MD, School of Public Health, University of California, Berkeley
• Aprajit Mahajan, PhD, Department of Agricultural & Resource Economics, University of California, Berkeley

​This research was funded by the Bill and Melinda Gates Foundation and FCDO (formerly UK DFID).

Dropbox link to my job market paper (November, 2021)