Radhika Jain
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Radhika Jain
@radhikajain.bsky.social
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Health/dev economist working on inequality, healthcare policy in India. Assistant Prof at UCL. Into dogs, secret lives of plants & animals, low budget travel.
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radhikajain.bsky.social
Our 2-part series on urban LMIC primary care is out. These are thick markets w many providers but variable quality. Rural frameworks focused on inadequate access don't apply. Instead, leverage competition, choice to shape mkts, reward high/push out low quality.
Abstract: Most people in low-income and middle-income countries (LMICs) now live in cities, as opposed to rural areas where access to care and provider choice is limited. Urban health-care provision is organised on very different patterns to those of rural care. We synthesise global evidence to show that health-care clinics are plentiful and easily accessible in LMIC cities and that they are seldom overcrowded. The costs that patients incur when they seek care are highly variable and driven mostly by drugs and diagnostics. We show that citizens have agency, often bypassing cheaper facilities to access preferred providers. Primary care service delivery in cities is thus best characterised as a market with a diverse range of private and public providers, where patients make active choices based on price, quality, and access. However, this market does not deliver high-quality consultations on average and does not provide continuity or integration of services for preventive care or long-term conditions. Since prices play a key role in accessing care, the most vulnerable groups of the urban population often remain unprotected.
May 1, 2025 at 6:30 PM