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Performance-based Financing (concepts (incentive Vs resource effect, NCMS,…
Performance-based Financing
China, Burundi, Cambodia
Why?
public sector absenteeism
low delivery rates for key interventions
low quality of care
capitation or salary-based incentives are weak incentives
appeal to donors of PBF
key concepts
contracting and business cycle
community empowerment
segregation of functions
autonomy (cash, hire and fire)
linking payment and results (indicators)
equity measures
conclusions for Burundi
some improvements in productivity and quality of care
phase 1 better than 2
limited impact on ANC and vaccination
initiating harder than continuing care
effects not pro-poor
additional administration costs are effective?
conclusions for Cambodia
PBF most impact if
contractor has management authority
financing linked to performance targets
sufficient incentives
combined with demand-side subsidies
no effects on mortality
quality of care not high enough?
concepts
incentive Vs resource effect
NCMS
OP
IP
HEFPA (Health Equity and Financial Protection in Asia)
P4P
FFS
MCH (Mother and Child Health)
conclusions for China
New Cooperative Medical Scheme (NCMS)
positive impact on IP and OP utilization
little or no impact on financial protection
why
demand-side challenges
only hospital care (high deductibles, low ceilings)
OOP still high
more hospital care utilization, but unequal
overuse of hospital care, neglect of primary care
conclusion: countries starting with generous hospital care in UHC will struggle later to reshift to primary care and regain cost control
supply-side challenges
perverse provider incentives
overprescribing
impact on antibiotics prescription (capitation + P4P rather than FFS)
reduced
but difficult to change patterns of inappropriate care delivery and patient expectation
Summary
provider incentives crucial
PBF good to improve MCH but
need demand-side intervention
easier to change provider behaviour when patients go to clinic
design: providers need autonomy