Can microcredit be profitable?

A new study by Burke, Bergquist, and Miguel suggests that it can. Not only that: it delivers positive spillovers. I write about it over at Let’s Talk Development.

Microcredit that helps more than just the borrower

Prices in African agricultural markets fluctuate a lot: “Grain prices in major markets regularly” rise “by 25-40% between the harvest and lean seasons, and often more than 50% in more isolated markets.” To an economist, this looks like a massive missed opportunity: Why don’t farmers just hold onto their harvested grain and sell at a much higher price during the lean season?

According to new work by researchers Burke, Bergquist, and Miguel, farmers in Kenya lack access to credit or savings opportunities, and so they “report selling their grain at low post-harvest prices to meet urgent cash needs (e.g., to pay school fees). To meet consumption needs later in the year, many then end up buying back grain from the market a few months after selling it.” It’s like the grain market is a very expensive source of short-term loans.

Can microcredit help? Offering farmers a loan at harvest led them to sell less at harvest time and to sell more grain later, when prices were higher. “The loan produces a return on investment of 28% over a roughly nine month period.”

Read more…

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What we learn from two new studies of patient satisfaction surveys

Over at Development Impact, I blog on two recent publications I had about how to better measure the patient experience in Nigeria.

Pitfalls of Patient Satisfaction Surveys and How to Avoid Them

A child has a fever. Her father rushes to his community’s clinic, his daughter in his arms. He waits. A nurse asks him questions and examines his child. She gives him advice and perhaps a prescription to get filled at a pharmacy. He leaves.

How do we measure the quality of care that this father and his daughter received? There are many ingredients: Was the clinic open? Was a nurse present? Was the patient attended to swiftly? Did the nurse know what she was talking about? Did she have access to needed equipment and supplies?

Both health systems and researchers have made efforts to measure the quality of each of these ingredients, with a range of tools. Interviewers pose hypothetical situations to doctors and nurses to test their knowledge. Inspectors examine the cleanliness and organization of the facility, or they make surprise visits to measure health worker attendance. Actors posing as patients test both the knowledge and the effort of health workers.

Read more…

For complex debates, an alternative to social media

There is an alternative to Twitter, Facebook and all those indignant op-eds that we use to confirm the superiority of our beliefs. It’s a flexible, troll-free, hacker-resistant platform on which complex social and moral questions can be carefully explored. It simultaneously engages our empathy and models the action of empathy for us. It’s called a novel.

That’s Ron Charles in the Washington Post.

I write it down so I don’t have to remember it

In the film Indiana Jones and the Last Crusade, Henry Jones — Indiana’s father — finds the key information needed to safely traverse a perilous journey to retrieve the Holy Grail.

Professor Henry Jones: Well, he who finds the Grail must face the final challenge.

Indiana Jones: What final challenge?

Professor Henry Jones: Three devices of such lethal cunning.

Indiana Jones: Booby traps?

Professor Henry Jones: Oh, yes. But I found the clues that will safely take us through them in the Chronicles of St. Anselm.

Indiana Jones: [pleased] Well, what are they?

[annoyed]

Indiana Jones: Can’t you remember?

Professor Henry Jones: I wrote them down in my diary so that I wouldn’t *have* to remember.

[Dialogue is documented at IMDB.com.]

Just yesterday, I wrote to a colleague asking for information, and he pointed me to a blog post that I wrote two months ago. I often keep my research findings straight, but — to adapt from Henry Jones — I write them down so that I don’t have to remember them! As University of Chicago professor Linda Ginzel tells her students, “If you don’t write it down, it doesn’t exist.”

In honor of the senior Dr. Jones, I made this little reminder…

How do researchers estimate regressions with patient satisfaction at the outcome? A brief review of practice

Recently, Anna Welander Tärneberg and I were doing research with patient satisfaction as the outcome, and we checked how other researchers had estimated these equations in the past. Here is what we found, as documented in the appendix of our recently published paper in the journal Health Economics.

chart

People use a lot of different methods, and many authors use multiple methods. But there is a rich history of using Ordinary Least Squares regressions to estimate impacts on patient satisfaction. In our paper, we used OLS but verified all the results with Probit and Logit regressions. To add to this list, Dunsch et al. (including me) have a new paper out last week on patient satisfaction in Nigeria, also using OLS as the main estimation method.

What were the best graphic books of 2017?

best graphicI’ve been reading more graphic books lately — graphic novels, graphic short stories, graphic memoirs, graphic biographies — and I’ve found that many outlets posted “best of 2017” lists.

I went through 15 “best of 2017” lists and identified the 100 graphic books that were recommended between them. A total of 10 books were recommended at least 3 “best of” lists. I’ve read half of the top 10, and they really are excellent, but there are many gems deeper down the list. So don’t stop digging.

The top 10 are listed below. The full list of 100 recommendations is available here. The numbering is funny because I use the same number — such 2a and 2b — if books received the same number of recommendations.

1. My Favorite Thing Is Monsters, by Ferris (recommended on 11 lists)

2a. The Best We Could Do: An Illustrated Memoir, by Bui (9 lists)

2b. Boundless, by Tamaki (9 lists)

4. Everything Is Flammable, by Bell (6 lists)

5. Hostage, by Delisle (5 lists)

6a. Imagine Only Wanting This, by Radtke (4 lists)

6b. Spinning, by Walden (4 lists)

8a. The Flintstones, Volume 1, by Russell & Pugh (3 lists)

8b. Shade the Changing Girl, Volume 1, by Castellucci & Zarcone (3 lists)

8c. You & a Bike & a Road, by Davis (3 lists)

Eight of the top ten are by women, which is cool (1, 2a, 2b, 4, 6a, 6b, 8b, and 8c).

Happy reading!

 

Are patients really satisfied?

Yesterday, my new paper — Bias in patient satisfaction surveys: a threat to measuring healthcare quality — was published at BMJ Global Health. It’s co-authored with Felipe Dunsch, Mario Macis, and Qiao Wang.

Here’s a quick rundown of what we learned.

Many health systems use patient satisfaction surveys to gauge one key element of health services: the patient experience. As part of evaluating an intervention to improve health care management in Nigeria, we piloted patient satisfaction questionnaires.

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A common way to measure patient satisfaction is to give patients a series of statements and to ask if they agree or disagree: “The clinic was clean.” “Staff explained your condition well.” That kind of thing. We noticed that people seemed to be agreeing with everything.

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Was that because the quality of care was good, or because saying yes is just easier?

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So we randomly assigned some patients to get the standard statements, and others to get negatively framed statements. “The clinic was dirty.” “Staff were rude.” “Staff explained your condition poorly.”

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Reframing the questions negatively led to significantly lower reports of patient satisfaction on almost every item.

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Sometimes the drops were big, as high as 12 percentage points and 19 percentage points.

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Our work was in Nigeria, but a lot of patient satisfaction questionnaires that we reviewed from a lot of countries use this positive framing.

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But that likely gives a falsely optimistic view of the patient experience.

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Patient satisfaction questionnaires that either mix positive and negative framing, or that avoid agree/disagree formats can do better.

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Of course, the quality of care is much more than patient satisfaction. But good health care systems can and should offer a positive patient experience.

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Check out the paper!