The Impact of a Pay-for-Performance Scheme on Prescription Quality in Rural China : Impact Evaluation

Sun, Xiaojie ; Liu, Xiaoyun ; Sun, Qiang ; Yip, Winnie ; Wagstaff, Adam ; Meng, Qingyue

World Bank, Washington, DC

关键词: ANTENATAL CARE;    CAPITATION;    CENTER FOR HEALTH;    CHILD HEALTH;    CHILD HEALTH SERVICES;   

DOI  :  10.1596/1813-9450-6892
RP-ID  :  WPS6892

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

In China, health care providers havetraditionally been paid fee-for-service and overprescribingand high out-of-pocket spending are common. In this study,township health centers in two counties were assigned almostrandomly to two groups: in one, fee-for-service was replacedby a global capitated budget; in the other, by a mix ofglobal capitated budget and pay-for-performance. Performancecaptured inter alia "irrational" drug prescribing;20 percent of the global capitated budget was withheld eachquarter, points were deducted for failure to meet targets,and some of the withheld budget was returned in line withthe points deducted. Outcomes included appropriateprescribing and prescription cost, data on which wereobtained by digitizing prescriptions from a month justbefore the reform and from the same month a year later.Impacts were assessed via multivariatedifferences-in-differences with township health center fixedeffects. To reduce bias from non-randomness in assignment,the sample was trimmed by coarsened exact matching.Pay-for-performance reduced inappropriate prescribingsignificantly and substantially in the county where theinitial level was above the penalty threshold, but end-linerates were still appreciable; no effects were seen in thecounty where initial levels were around or below thethreshold, or on out-of-pocket spending in either county.