Market competition and demand for skills in a credence goods market: Evidence from face-to-face and web-based non-physician clinician training in rural China.

Hongmei Yi,Dirk E Teuwen,Xiaoyuan Zhang,Sean Sylvia,Paiou Wu,Petri Böckerman

doi:10.1371/journal.pone.0233955

Abstract

BackgroundNon-physician clinicians (NPCs) providing services in functionally private markets account for a large share of the workforce in the primary care system in many low-income and middle-income countries. Although regular in-service training is believed to be crucial to updating NPCs’ professional knowledge, skills, and practices, participation rates are often low. Low participation may result from the “credence good” nature of the market for primary care: if patients are unable to observe quality improvements from training, NPCs have weaker incentives to participate. Empirical evidence is limited on the relationship between market competition and NPC participation in-service training as well as how participation varies with the type of training available.MethodsThe study uses a dataset of 301 NPCs from three prefectures in Yunnan, a province in southwest China, collected in July 2017. Logistic regression is used to estimate the relationship between competition and NPC’s participation in in-service training. We assess the relationship between participation and both the quantity of competition (number of competitors in the same village and surrounding villages) and the quality of competition (proxied using characteristics of competing clinicians).ResultsIn 2016, nearly two thirds of NPCs participated in face-to-face or web-based in-service trainings at least once. Specifically, 58 percent of NPCs participated in face-to-face in-service trainings, and 24 percent of NPCs participated in web-based in-service trainings. The quantity of competitors is unrelated to participation in in-service training. The quality of competition is not related to face-to-face training but has a significant positive relationship with participation in web-based training.ConclusionsWeb-based trainings may be a better approach to increase NPC skills in developing country primary care markets.

Highlights

Non-physician clinicians (NPCs) account for a large share of the workforce in the primary care system in many low-income and middle-income countries
Empirical evidence is limited on the relationship between market competition and NPC participation in-service training as well as how participation varies with the type of training available
In 2016, nearly two thirds of NPCs participated in face-to-face or web-based in-service trainings at least once

Summary

Background

Non-physician clinicians (NPCs) providing services in functionally private markets account for a large share of the workforce in the primary care system in many low-income and middle-income countries. Low participation may result from the “credence good” nature of the market for primary care: if patients are unable to observe quality improvements from training, NPCs have weaker incentives to participate. Empirical evidence is limited on the relationship between market competition and NPC participation in-service training as well as how participation varies with the type of training available. UCB provided support in the form of a salary for author DET but neither UCB nor the RCSC had any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Methods

Results

Introduction

Conclusion with discussion