at baseline and facilities exiting the market with patient safety scores below the weighted baseline mean of their market.<sup>22</sup> Having computed the decomposition for each market, we then compare treatment and control markets to estimate the impact of the intervention on each component.

Table 6, column 1 shows that 87% of the total increase in the (patient-weighted) JHIC score of 3.6 percentage points (p-value _<_ 0.010), is driven by “within” health facilities changes.<sup>23</sup> The exit of facilities with quality below the market baseline mean contributes only 5% of total impact (p-value = 0.013) with reallocation of patients across facilities barely contributing to the overall improvement. Therefore, gains in the JHIC score for the average patient was primarily due to improvements within facilities, rather than reallocation, exits or entries. This reflects the fact that entering facilities account for less than 12% of market share and exiting facilities less than 3% of market share and that patient reallocations are among facilities with similar quality, as we would expect if movers are “marginal.” Figure A6 presents robustness checks, which do not change the main results presented here.

Table 6: Treatment Effects on Weighted JHIC Score and Decomposition Components Percentage Points of Maximum JHIC Score

||||Co|ntribution|||
|---|---|---|---|---|---|---|
||Total Impact|Within|Between|Cross|Entry|Exit|
||(1)|(2)|(3)|(4)|(5)|(6)|
|Treatment|3_._559***|3_._080***|0_._298|_−_0_._046|0_._044|0_._182**|
||(0_._933)<br>[0_._000]|(0_._876)<br>[0_._001]|(0_._309)<br>[0_._335]|(0_._277)<br>[0_._869]|(0_._159)<br>[0_._782]|(0_._073)<br>[0_._013]|
|Control Mean|_−_0_._314|_−_0_._331|0_._047|0_._065|_−_0_._294|0_._200|
|Observations (Markets)|252|252|252|252|252|252|
|Observations (Facilities)|1303|1303|1303|1303|1303|1303|

_Notes_ . Robust standard errors are reported in parentheses and p-values are reported in brackets. *** (**) (*) denotes significance at 1% (5%) (10%) level. Regressions include randomization strata controls (by county and market size) and control for the percentage of health facilities of each level in the market.

# **IV.4 Cost**

The operational cost of this intervention during the pilot phase was USD 165 per visit, which includes inspections and visits for the enforcement of warnings and sanctions, as well as closures of facilities and/or departments within facilities. Multiple factors would allow us to reduce the costs in a scaled-up version to USD 95 per visit. With an average of 3 visits (2 inspections) per

> 22This analysis includes 92% of the markets identified at randomization. We restrict the sample to markets that were active at both baseline and endline and exclude markets where missing data accounts for more than 30% of the share in the market at any period. We also exclude facilities with missing data. These restrictions reduce the total sample by 15% of all facilities (11% of facilities active at baseline and 10% of facilities active at endline), which account for 3.0% of patients in the baseline and 4.8% in the endline.

> 23The difference with the weighted impact presented in Table 3 stems from a slightly different sample due to the restriction to markets open at baseline and endline as explained in the previous footnote.

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