Patient Reporting Reticence from Social Proximity
RCTClinical Trial
Participatory bottom-up monitoring schemes rely on citizens filing complaints against underperforming service providers, but citizen uptake is frequently low. Existing social connections and fear of retribution can deter citizens from reporting provider misconduct.
Picture this
Imagine visiting a local neighborhood store where the owner overcharges you, but because the owner is a neighbor you interact with regularly, you choose not to report the infraction to a watchdog agency to avoid personal conflict, guilt, or informal retaliation.
What the evidence says
Patients were 7.4 to 10.3 percentage points less likely to file complaints when complaints led to tangible monetary or peer-shaming consequences for providers (a 25% to 33% reduction from the Complaint Box mean of 29.3%), driven primarily by patients who personally recognized health workers participating in the session.
- Who was studied
- N = 164 trusting patients (subsample of 216 total patients who sent positive amounts in the game) recruited from public and private health facilities in Nairobi, Kenya.
- How
- Strategy elicitation method measuring patients' binary choices to file complaints and the number of complaint cards sent (0 to 5 cards at 50 KES lump cost), comparing treatments with tangible provider penalties against a standard Complaint Box control.
What to do
Design citizen reporting channels with complete individual anonymity and external third-party data collection to eliminate social friction and fear of retaliation when reporting local service providers.
From the source
"when complaints lead to tangible consequences (either monetary or non-monetary) for providers, patients are less willing to file such complaints, mainly due to the existence of personal relationships with providers."
e7b318f7-c10f-44ea-935a-6f4ab3cde66a-Health Workers’ Behavior, Patient Reporting and Reputational Concerns- Lab-in-the-Field Experimental Evidence from Kenya.pdf