Is Doctor's knowledge the major limiting factor to quality healthcare?

Why is the quality of medical care substandard in India? Is it because of a lack of medical professionals, or the fact that the public sector improperly trains many of them? One paper that has recently been published tries to test out the assumption that the major reason why the quality is generally low is because of a lack of knowledge on the parts of the doctors. The paper, which is explained on Ending Poverty in South Asia, separates along two criteria — that which doctors know and that which doctors do.

What doctors know—measured by testing doctors—represents the maximum care that a doctor could provide. What doctors do—measured by watching doctors—represents the care they actually provide to real patients. We call the first “competence” and the second “practice quality”.

The paper’s findings are after the jump.

First, public sector doctors always do a lot less than their private sector counterparts—between 66 and 50 percent less depending on how competent they were to begin with. Second, even in the private sector, there is a large gap between knowledge and practice. Doctors who correctly covered 60 percent of essential tasks when tested ended up covering just over 30 percent when dealing with actual patients. Third, about the only “doctors” who are practicing at the frontier of their knowledge are those with very low competence—those who covered 20 percent or less of essential tasks when tested.

These conclusions raise some troubling issues. First, the utility of additional training for doctors seems limited beyond the most basic levels, since they are unlikely to use this additional knowledge in practice. Second, this suggests that doctors need exogenous pressures to improve quality of care as their own desire to provide the highest level of affordable care is insufficient to ensure quality control.

The paper suggested other factors that may contribute to this such as a lack of well-defined malpractice laws and legal liabilities. However, the paper does recognize that before such hypotheses can be confirmed, a similar study on rich countries must also be conducted.