Do doctors contribute to socioeconomic inequalities in health care provision? An audit experiment in Tunisia
通过向突尼斯130名公立和私立初级保健医生派遣标准化病人，研究医生是否因患者社会经济背景不同而区别对待，发现医生对贫困患者开更少昂贵药、给更多免费药，但向富裕患者提供更多诊断和治疗解释。
In this paper, we explore an important but understudied driver of health inequalities: whether doctors treat patients from different socioeconomic backgrounds differently during a clinical encounter. We design an audit experiment in Tunisia, sending standardised patients with the same symptoms to 130 public and private primary care doctors for consultation. Informed by in-depth qualitative work, we vary the attitude and appearance of the patients so that they appear to be "poor" or "middle-class". We find no evidence that doctors manage patients differently, but they respond to the socioeconomic profile of patients by prescribing fewer expensive drugs and giving out more free drugs to poorer patients. We also show significant differences in communication between patients: doctors are more likely to provide more explanation to richer patients about the diagnosis, the drugs prescribed and the treatment plan. These differences are not explained by time constraints as doctors spent comparable time with both types of patients. To the extent that differences in communication with patients can lead to differences in patients' health decisions, our results suggest that doctors could contribute indirectly to health inequalities.