Use of standardised patients for healthcare quality research in low- and middle-income countries.

The use of standardised patients (SPs)-people recruited from the local community to present the same case to multiple providers in a blinded fashion-is increasingly used to measure the quality of care in low-income and middle-income countries. Encouraged by the growing interest in the SP method, and based on our experience of conducting SP studies, we present a conceptual framework for research designs and surveys that use this methodology. We accompany the conceptual framework with specific examples, drawn from our experience with SP studies in low-income and middle-income contexts, including China, India, Kenya and South Africa, to highlight the versatility of the method and illustrate the ongoing challenges.

Variations in the quality of tuberculosis care in urban India: A cross-sectional, standardized patient study in two cities.

Background: India has the highest burden of tuberculosis (TB). Although most patients with TB in India seek care from the private sector, there is limited evidence on quality of TB care or its correlates. Following our validation study on the standardized patient (SP) method for TB, we utilized SPs to examine quality of adult TB care among health providers with different qualifications in 2 Indian cities.

Use of standardised patients to assess antibiotic dispensing for tuberculosis by pharmacies in urban India: a cross-sectional study.

Background: India's total antibiotic use is the highest of any country. Patients often receive prescription-only drugs directly from pharmacies. Here we aimed to assess the medical advice and drug dispensing practices of pharmacies for standardised patients with presumed and confirmed tuberculosis in India.

Has the Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh Addressed the Educational Divide in Accessing Health Care?

Background: Equity of access to healthcare remains a major challenge with families continuing to face financial and non-financial barriers to services. Lack of education has been shown to be a key risk factor for 'catastrophic' health expenditure (CHE), in many countries including India. Consequently, ways to address the education divide need to be explored.

Use of standardised patients to assess quality of tuberculosis care: a pilot, cross-sectional study.

Background: Existing studies of the quality of tuberculosis care have relied on recall-based patient surveys, questionnaire surveys of knowledge, and prescription or medical record analysis, and the results mostly show the health-care provider's knowledge rather than actual practice. No study has used standardised patients to assess clinical practice. Therefore we aimed to assess quality of care for tuberculosis using such patients.

Private sector participation in delivering tertiary health care: a dichotomy of access and affordability across two Indian states.

Unlabelled: Poor quality care in public sector hospitals coupled with the costs of care in the private sector have trapped India's poor in a vicious cycle of poverty, ill health and debt for many decades. To address this, the governments of Andhra Pradesh (AP) and Maharashtra (MH), India, have attempted to improve people's access to hospital care by partnering with the private sector. A number of government-sponsored schemes with differing specifications have been launched to facilitate this strategy.

Using the Indian National Sample Survey data in public health research.

The National Sample Survey (NSS), instituted in 1950, was the brainchild of Professor Mahalanobis, widely regarded as the father of Indian statistics.1 His ambition was to obtain and quantify comprehensive information on an annual basis on the socio- economic, demographic, agricultural and other profiles of the country, both at the national and state levels. The NSS is a multi- stage, multi-subject and multi-purpose cross-sectional survey, which is conducted annually and covers topics of current interest.

Changes in addressing inequalities in access to hospital care in Andhra Pradesh and Maharashtra states of India: a difference-in-differences study using repeated cross-sectional surveys.

Objectives: To compare the effects of the Rajiv Aarogyasri Health Insurance Scheme of Andhra Pradesh (AP) with health financing innovations including the Rashtriya Swasthya Bima Yojana (RSBY) in Maharashtra (MH) over time on access to and out-of-pocket expenditure (OOPE) on hospital inpatient care.

Study Design: A difference-in-differences (DID) study using repeated cross-sectional surveys with parallel control.

Setting: National Sample Survey Organisation of India (NSSO) urban and rural 'first stratum units', 863 in AP and 1008 in MH.