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

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.