Dupas, Pascaline; Jain, Radhika; (2023) Can beneficiary information improve hospital accountability? Experimental evidence from a public health insurance scheme in India. Journal of Public Economics , 220 , Article 104841. 10.1016/j.jpubeco.2023.104841.

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Abstract

We study hospital compliance with a public health insurance program in a large Indian state. Using patient surveys, we first document that participating hospitals regularly charge fees to patients eligible to receive free care, resulting in high levels of out-of-pocket payments in and outside the hospital; and that eligible patients lack information about the program. To test whether information is sufficient to enable intended beneficiaries to hold hospitals accountable, we conduct a randomized phone-based information intervention among approximately 1,100 patients requiring chronic kidney disease management. We find that the intervention effectively increases program awareness and triggers some patients to switch provider, but has heterogeneous impacts on patients' ability to obtain cheaper or more comprehensive care. The intervention dramatically reduced out-of-pocket payments for patients at public hospitals, but not at private hospitals. Our findings suggest patient-driven accountability is an important tool in improving service delivery, but may not substitute for top-down monitoring in the context of specialized tertiary care.

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