What drives poor quality of care for child diarrhea? Experimental evidence from India

<p>Most healthcare providers in developing countries know that oral rehydration salts (ORS) is a lifesaving treatment for child diarrhea, yet few prescribe it. This know-do gap has puzzled experts for decades and has cost millions of lives. Using several randomized controlled trials among private providers in 253 towns in India, we estimated the extent to which ORS under-prescription is driven by financial incentives to sell more lucrative medicines, stock-outs of ORS, and provider perceptions that patients do not want ORS. We found that patients expressing a preference for ORS increased ORS prescribing by 27 percentage points. Eliminating stock-outs increased ORS provision by 6.8 percentage points. Eliminating financial incentives to sell medicines had no effect on average but increased ORS prescribing at pharmacies by 9 percentage points. Our findings, combined with patient exit surveys suggest that provider perceptions that patients do not want ORS explain 42% of under-prescribing, while stock-outs and financial incentives explain only 6% and 5% respectively.</p>