Payment for performance can improve health services

January 01, 0001

Payment for performance can improve health services

Evidence about the best methods with which to accelerate progress towards achieving the Millennium Development Goals is urgently needed. The researchers assessed the effect of performance-based payment of health- care providers (payment for performance; P4P) on use and quality of child and maternal care services in health-care facilities in Rwanda. 166 facilities were randomly assigned at the district level either to begin P4P funding between June, 2006, and October, 2006 (intervention group; n=80), or to continue with the traditional input-based funding until 23 months after study baseline (control group; n=86). Randomisation was done by coin toss. The researchers surveyed facilities and 2158 households at baseline and after 23 months.

The model estimated that facilities in the intervention group had a 23% increase in the number of institutional deliveries and increases in the number of preventive care visits by children aged 23 months or younger (56%) and aged between 24 months and 59 months (132%). No improvements were seen in the number of women completing four prenatal care visits or of children receiving full immunisation schedules. They also estimate an increase of 0.157 standard deviations in prenatal quality as measured by compliance with Rwandan prenatal care clinical practice guidelines.

The researchers concluded: "The P4P scheme in Rwanda had the greatest effect on those services that had the highest payment rates and needed the least effort from the service provider. P4P financial performance incentives can improve both the use and quality of maternal and child health services, and could be a useful intervention to accelerate progress towards Millennium Development Goals for maternal and child health."

This is not externally generalizable.

For the full abstract, click here.

The Lancet 377(9775):1421-1428, 23 April 2011
© 2011 Elsevier Limited
Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation. Paulin Basinga, Paul J Gertler, Agnes Binagwaho et al. Correspondence to Paul J Gertler: [email protected]

Category: HSR. Health Services Research. Keywords: maternal, child health, services, payment, primary health care, providers, performance, Rwanda, impact evaluation, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 20 May 2011

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