Working Papers

To assess socioeconomic differences in access to high-quality health care services, we collected novel data on illnesses that required primary care from 23,275 households in 100 villages in Madhya Pradesh, India. We matched the primary care visits for those illnesses to characteristics of the health care providers that members of the households visited. People in the average village in our sample could access eleven providers, of whom 71 percent were in the private sector and 49 percent had no formal medical training. The private sector accounted for 89 percent of the primary care visits in our sample, with 77 percent of the visits made to providers with no formal training. Both access to and use of more knowledgeable providers increased with socioeconomic status, mostly as a result of differences across districts and villages. Strikingly, people in high- and low-socioeconomic-status households in the same village visited equally knowledgeable providers. It was the poor people who lived in poor communities who received especially low-quality care.