Kenneth Lynch Leonard
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Kenneth Lynch Leonard
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Go directly to: Working Papers, Published Papers, Data and Instruments
If you would like contact info, or information about classes that I teach please go to my main page
My area of research is the delivery of key public services to rural populations in developing countries and most of my work has focused on the delivery of curative health services in such areas. My early work in this area, “African Traditional Healers and Outcome-Contingent Contracts in Health Care” (Journal of Development Economics) and Outcome Versus Service Based Payment in Health Care: Lessons from African Traditional Healers” (Health Economics) focused on the role played by traditional healers and particularly on the lessons for modern health care delivery that can be drawn from their continued popularity. These lessons, as applied to modern sector providers, point to the non-governmental (NGO) sector as a potentially important organizational form for service delivery. Papers on this subject include “When Both States and Markets Fail: Asymmetric Information and the Role of NGOs in African Health Care” (International Review of Law and Economics) and “The Political Economy of Improving Health Care for the Poor in Rural Africa: Institutional Solutions to the Principal-Agent Problem” (Journal of Development Studies), “Getting doctors to do their best: the roles of ability and motivation in health care quality” (Journal of Human Resources), and “Variation in the quality of care accessible to rural communities in Tanzania” (Health Affairs).
I administered an NSF and World Bank-funded research project in the Arusha region of Tanzania that sought to tie objective measures of health care quality to households' subjective assessment of the quality of care available to them. In order to do this, (together with Dr. Masatu of CEDHA) I developed two new data collection instruments to measure the quality of care available in health facilities. Together with similar work by colleagues at the World Bank, this has led to a better understanding of how to use key survey instruments in developing countries. Papers on this subject include, “Outpatient process quality evaluation and the Hawthorne Effect” and “Comparing vignettes and direct clinician observation in a developing country context” (both in Social Science & Medicine). My current research focuses on showing how information about quality of care is shared in rural communities and how households use this information to improve outcomes by choosing the most appropriate doctors for their illnesses. Papers on this subject include, “Learning in Health Care: Evidence of learning about clinician quality in Tanzania” (Economic Development and Cultural Change) and “Bypassing Health Centers in Tanzania: Revealed Preferences for Observable and Unobservable Quality” (Journal of African Economies). Ongoing work in this area uses households’ direct knowledge of the health histories of other households in their village to measure the degree to which household accumulate and adapt to new information about quality.
In addition, my current work examines how policy responses to poor health can take into account the behavior of households. Specifically, if households know about quality, and are willing to travel to obtain it, then the value of reducing travel costs can easily exceed the value of training and posting more low-quality doctors in rural areas. Together with Dr. Paul McNamara (of the University of Illinois) and Dr. John Ulimwengo (of IFPRI), I am using this new understanding of the real quality of health care, and household responses to the variation in health care quality to improve our understanding of the link between health care, health and labor productivity in the rural areas of poor countries.
Econometrically, I am particularly interested in new instruments for the impact of professional effort (see “Is patient satisfaction sensitive to changes in the quality of care? An exploitation of the Hawthorne Effect” (Journal of Health Economics)), discrete choice modeling with large sets of choices (where IIA is unlikely to hold) and methods for estimating unobserved latent variables (such as doctor competence or quantitative illness characteristics) when there are at least two unobserved dimensions affecting measurement.
The papers listed below are part of my active research agenda.
Links to Published or Accepted Manuscripts:
Information related to my empirical work in Tanzania, including instruments used for surveys and the forms used in experimental settings in Tanzania and India: Instruments
I am working on making available data files that have been pre-processed, in other words easy to examine. However the raw data for my papers on health care in Cameroun are available at the The Inter-university Consortium for Political and Social Research (ICPSR). To reach my data go to the search page and search for study number 1138.
Interviews with Traditional Healers:
As part of my study I interviewed traditional healers in Cameroun, Tanzania and Ethiopia. If you would like to read the notes of these interviews you should download this pdf file (tradheal_inter.pdf). The identities of the interviewee's cannot be released, but you probably don't need this information. The surveys are open-ended, so not all of the same questions were posed to all healers. I took notes during the interviews and wrote up my notes on the same day as the interview was completed.
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