Paying Primary Health Care Centers for Performance in Rwanda

Basinga, Paulin ; Gertler, Paul J. ; Soucat, Agnes L.B. ; Binagwaho, Agnes ; Soucat, Agnes L.B. ; Sturdy, Jennifer R. ; Vermeersch, Christel M.J.

World Bank, Washington, DC

关键词: ALCOHOL;    ALCOHOL USE;    ANEMIA;    ANTENATAL CARE;    BLEEDING;   

DOI  :  10.1596/1813-9450-5190
RP-ID  :  WPS5190

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

Paying for performance (P4P) providesfinancial incentives for providers to increase the use andquality of care. P4P can affect health care by providingincentives for providers to put more effort into specificactivities, and by increasing the amount of resourcesavailable to finance the delivery of services. This paperevaluates the impact of P4P on the use and quality ofprenatal, institutional delivery, and child preventive careusing data produced from a prospective quasi-experimentalevaluation nested into the national rollout of P4P inRwanda. Treatment facilities were enrolled in the P4P schemein 2006 and comparison facilities were enrolled two yearslater. The incentive effect is isolated from the resourceeffect by increasing comparison facilities' input-basedbudgets by the average P4P payments to the treatmentfacilities. The data were collected from 166 facilities anda random sample of 2158 households. P4P had a large andsignificant positive impact on institutional deliveries andpreventive care visits by young children, and improvedquality of prenatal care. The authors find no effect on thenumber of prenatal care visits or on immunization rates. P4Phad the greatest effect on those services that had thehighest payment rates and needed the lowest provider effort.P4P financial performance incentives can improve both theuse of and the quality of health services. Because theanalysis isolates the incentive effect from the resourceeffect in P4P, the results indicate that an equal amount offinancial resources without the incentives would not haveachieved the same gain in outcomes.