What drives poor quality of care for child diarrhea? Experimental evidence from India. (https://pubmed.ncbi.nlm.nih.gov/38330118/)

These scientists wanted to understand why doctors in some countries don't give a special medicine called oral rehydration salts (ORS) to children with diarrhea, even though it can save their lives and is not expensive. They did a study in India to find out why this happens.

First, they randomly tested different methods to see if they could increase the number of doctors who prescribe ORS. One method they tried was asking the patients if they wanted ORS. They found that when patients said they wanted ORS, doctors were more likely to prescribe it. This increased the number of prescriptions by 27%.

Next, the scientists looked at another reason why doctors might not prescribe ORS. They found that sometimes the medicine was not available in the pharmacies, which is called a stock-out. They discovered that when the medicine was always available, more doctors prescribed it. This increased the number of prescriptions by 7%.

Lastly, the scientists wanted to see if money influenced the doctors' decision to prescribe ORS. They found that removing the financial incentives, which means doctors were not paid extra for prescribing ORS, did not change the number of prescriptions on average. However, they found that in pharmacies, where people buy medicine, removing the financial incentives did increase the number of ORS prescriptions.

In conclusion, the scientists discovered that the main reason why doctors don't prescribe ORS is because they think patients don't want it. This explains 42% of the underprescription. Stock-outs and financial incentives only explain a small part of the problem, 6% and 5% respectively. The scientists hope that by understanding these reasons, they can help more children get the medicine they need to feel better when they have diarrhea.

Wagner Z., Mohanan M., Zutshi R., Mukherji A., Sood N. What drives poor quality of care for child diarrhea? Experimental evidence from India. Science. 2024 Feb 9;383(6683):eadj9986. doi: 10.1126/science.adj9986. Epub 2024 Feb 9.