Variations in doctor effort: evidence from Paraguay.

This paper analyzes how doctors' practices in Paraguay differ across patients, physicians, and facilities. In the absence of claims or chart data, we constructed a measure of "doctor effort" based on observations of doctor-patient interactions. There is little difference in effort for patients from different backgrounds, but large differences across physicians and facilities. Female doctors, doctors on temporary contracts, and doctors in certain types of facilities provide greater effort; those with higher salaries exert less effort. The results suggest that ensuring access to high-quality care is essential, but whether doctors will discriminate against patients might be less of a concern.