Doctor Competence and the Demand for Healthcare: Evidence from Rural China.

The agency problem between patients and doctors has long been emphasised in the health economics literature, but the empirical evidence on whether patients can evaluate and respond to better quality care remains mixed and inconclusive. Using household data linked to an assessment of village doctors' clinical competence in rural China, we show that there is no correlation between doctor competence and patients' healthcare utilisation, with confidence intervals reasonably tight around zero. Household perceptions of quality are an important determinant of care-seeking behaviour, yet patients appear unable to recognise more competent doctors - there is no relationship between doctor competence and perceptions of quality. Copyright © 2016 John Wiley & Sons, Ltd.

Parálisis braquial obstétrica en el contexto de la rehabilitación física temprana / Obstetric Brachial Plexus Palsy in the Context of Early Physical Rehabilitation

En la actualidad el sistema de salud cubano promueve el estudio prenatal y el seguimiento del embarazo; a pesar de esto la parálisis braquial obstétrica continúa siendo una consecuencia desafortunada tras un parto difícil y constituye uno de los traumatismos obstétricos más frecuentes. Su tratamiento ha sido tradicionalmente conservador, basado en el seguimiento multidisciplinario y consultas a los distintos especialistas para tratar las secuelas. Luego de realizar una amplia revisión bibliográfica, en este artículo se exponen la etiología, anatomía, fisiopatología, tipos de lesiones, pronóstico y evolución, secuelas, instrumentos de evaluación, tratamientos existentes y ejercicios para la parálisis braquial obstétrica.

Cuban health system currently promotes prenatal testing and monitoring of pregnancy; nevertheless obstetric brachial plexus palsy remains an unfortunate consequence of a difficult delivery and is one of the most common birth trauma. Traditionally, its treatment has been conservative, based on multidisciplinary monitoring and consultations with various specialists to deal with the consequences. After conducting an extensive literature review, we discussed in this paper the etiology, anatomy, pathophysiology, types of injuries, prognosis and outcome, consequences, assessment tools, existing treatments and series of exercises for obstetric brachial plexus palsy.

Capitation combined with pay-for-performance improves antibiotic prescribing practices in rural China.

Pay-for-performance in health care holds promise as a policy lever to improve the quality and efficiency of care. Although the approach has become increasingly popular in developing countries in recent years, most policy designs do not permit the rigorous evaluation of its impact. Thus, evidence of its effect is limited. In collaboration with the government of Ningxia Province, a predominantly rural area in northwest China, we conducted a matched-pair cluster-randomized experiment between 2009 and 2012 to evaluate the effects of capitation with pay-for-performance on primary care providers' antibiotic prescribing practices, health spending, outpatient visit volume, and patient satisfaction. We found that the intervention led to a reduction of approximately 15 percent in antibiotic prescriptions and a small reduction in total spending per visit to village posts-essentially, community health clinics. We found no effect on other outcomes. Our results suggest that capitation with pay-for-performance can improve drug prescribing practices by reducing overprescribing and inappropriate prescribing. Our study also shows that rigorous evaluations of health system interventions are feasible when conducted in close collaboration with the government.