title: Survey using incognito standardized patients shows poor quality care in China's rural clinics.
abstract: Over the past decade, China has implemented reforms designed to expand access to health care in rural areas. Little objective evidence exists, however, on the quality of that care. This study reports results from a standardized patient study designed to assess the quality of care delivered by village clinicians in rural China. To measure quality, we recruited individuals from the local community to serve as undercover patients and trained them to present consistent symptoms of two common illnesses (dysentery and angina). Based on 82 covert interactions between the standardized patients and local clinicians, we find that the quality of care is low as measured by adherence to clinical checklists and the rates of correct diagnoses and treatments. Further analysis suggests that quality is most strongly correlated with provider qualifications. Our results highlight the need for policy action to address the low quality of care delivered by grassroots providers.
authors.affiliation: School of Economics, Renmin University of China, 59 Zhongguancun Avenue, Beijing, 100872 China, Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, 199 South Chang'an Road, Xi'an, Shaanxi, 710062 China, School of Economics and Management, Northwest University, No. 1 Xuefu Da Road, Xi'an, Shaanxi, 710127 China, Shaanxi No. 4 Provincial People's Hospital, 512 Xianning East Rd, Xi'an, Shaanxi, 710043 China and Freeman Spogli Institute for International Studies, Stanford University, 616 Serra Street, Stanford, CA 94305, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Sylvia
authors.affiliation: School of Economics, Renmin University of China, 59 Zhongguancun Avenue, Beijing, 100872 China, Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, 199 South Chang'an Road, Xi'an, Shaanxi, 710062 China, School of Economics and Management, Northwest University, No. 1 Xuefu Da Road, Xi'an, Shaanxi, 710127 China, Shaanxi No. 4 Provincial People's Hospital, 512 Xianning East Rd, Xi'an, Shaanxi, 710043 China and Freeman Spogli Institute for International Studies, Stanford University, 616 Serra Street, Stanford, CA 94305, USA shiyaojiang7@gmail.com.
authors.forename: Yaojiang
authors.initials: Y
authors.lastname: Shi
authors.affiliation: School of Economics, Renmin University of China, 59 Zhongguancun Avenue, Beijing, 100872 China, Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, 199 South Chang'an Road, Xi'an, Shaanxi, 710062 China, School of Economics and Management, Northwest University, No. 1 Xuefu Da Road, Xi'an, Shaanxi, 710127 China, Shaanxi No. 4 Provincial People's Hospital, 512 Xianning East Rd, Xi'an, Shaanxi, 710043 China and Freeman Spogli Institute for International Studies, Stanford University, 616 Serra Street, Stanford, CA 94305, USA.
authors.forename: Hao
authors.initials: H
authors.lastname: Xue
authors.affiliation: School of Economics, Renmin University of China, 59 Zhongguancun Avenue, Beijing, 100872 China, Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, 199 South Chang'an Road, Xi'an, Shaanxi, 710062 China, School of Economics and Management, Northwest University, No. 1 Xuefu Da Road, Xi'an, Shaanxi, 710127 China, Shaanxi No. 4 Provincial People's Hospital, 512 Xianning East Rd, Xi'an, Shaanxi, 710043 China and Freeman Spogli Institute for International Studies, Stanford University, 616 Serra Street, Stanford, CA 94305, USA.
authors.forename: Xin
authors.initials: X
authors.lastname: Tian
authors.affiliation: School of Economics, Renmin University of China, 59 Zhongguancun Avenue, Beijing, 100872 China, Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, 199 South Chang'an Road, Xi'an, Shaanxi, 710062 China, School of Economics and Management, Northwest University, No. 1 Xuefu Da Road, Xi'an, Shaanxi, 710127 China, Shaanxi No. 4 Provincial People's Hospital, 512 Xianning East Rd, Xi'an, Shaanxi, 710043 China and Freeman Spogli Institute for International Studies, Stanford University, 616 Serra Street, Stanford, CA 94305, USA.
authors.forename: Huan
authors.initials: H
authors.lastname: Wang
authors.affiliation: School of Economics, Renmin University of China, 59 Zhongguancun Avenue, Beijing, 100872 China, Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, 199 South Chang'an Road, Xi'an, Shaanxi, 710062 China, School of Economics and Management, Northwest University, No. 1 Xuefu Da Road, Xi'an, Shaanxi, 710127 China, Shaanxi No. 4 Provincial People's Hospital, 512 Xianning East Rd, Xi'an, Shaanxi, 710043 China and Freeman Spogli Institute for International Studies, Stanford University, 616 Serra Street, Stanford, CA 94305, USA.
authors.forename: Qingmei
authors.initials: Q
authors.lastname: Liu
authors.affiliation: School of Economics, Renmin University of China, 59 Zhongguancun Avenue, Beijing, 100872 China, Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, 199 South Chang'an Road, Xi'an, Shaanxi, 710062 China, School of Economics and Management, Northwest University, No. 1 Xuefu Da Road, Xi'an, Shaanxi, 710127 China, Shaanxi No. 4 Provincial People's Hospital, 512 Xianning East Rd, Xi'an, Shaanxi, 710043 China and Freeman Spogli Institute for International Studies, Stanford University, 616 Serra Street, Stanford, CA 94305, USA.
authors.forename: Alexis
authors.initials: A
authors.lastname: Medina
authors.affiliation: School of Economics, Renmin University of China, 59 Zhongguancun Avenue, Beijing, 100872 China, Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, 199 South Chang'an Road, Xi'an, Shaanxi, 710062 China, School of Economics and Management, Northwest University, No. 1 Xuefu Da Road, Xi'an, Shaanxi, 710127 China, Shaanxi No. 4 Provincial People's Hospital, 512 Xianning East Rd, Xi'an, Shaanxi, 710043 China and Freeman Spogli Institute for International Studies, Stanford University, 616 Serra Street, Stanford, CA 94305, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Rozelle
mesh_terms: D002681:China; D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D016544:Patient Simulation; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012424:Rural Population; D011795:Surveys and Questionnaires
keywords: China; Physician quality; standardized patients