Financial Incentives

A case-control, quasi-experimental study was designed to investigate the effect of a performance-based incentive payment scheme on behaviours of public-sector service providers in delivering a basic package of maternal and child-health services in Egyptian primary healthcare units. [from abstract]

Pay-for-performance (P4P) is one of the primary tools used to support healthcare delivery reform. This paper summarizes evidence, obtained from studies published between January 1990 and July 2009, concerning P4P effects, as well as evidence on the impact of design choices, and contextual mediators on these effects. [from abstract]

This case study provides an example of a broad public sector pay for performance approach that incorporates intergovernmental transfers in a decentralized context with rewards for concrete health results at the facility level and the challenges of moving from design to implementation. [from author]

This case study thus describes an example of a private sector pay for performance voucher program targeting reproductive health and offers lessons for countries that are considering implementing similar schemes. [from author]

This case study presents the initial results of the pay-for-performance (P4P) experience of UNIMED-Belo Horizonte, a private, nonprofit organization in Brazil and provides an example of private sector P4P to improve service quality and efficiency. [from author]

This review shows how lessons that have been learned from international experiences have been improved further in China by realignment of the incentives for providers towards prevention and primary care, and incorporation of a treatment protocol for hospital services. [from summary]

Paying for performance (P4P) provides financial incentives for providers to increase the use and quality of care. This paper evaluates the impact of P4P on the use and quality of prenatal, institutional delivery, and child preventive care using data produced from a prospective quasi-experimental evaluation nested into the national rollout of P4P in Rwanda. [from abstract]

Financial incentives have been used for many years internationally to improve quality of care in general practice. The aim of this pilot study was to determine if offering general practitioners a small incentive payment per test would increase chlamydia testing in women aged 16 to 24 years, attending general practice. [from abstract]

This book explores a new approach to health funding, the transfer of money or goods to patients or providers when they take health-related actions or achieve performance targets. It documents a host of experiences with incentives for maternal and child health care, tuberculosis, child nutrition, HIV/AIDS, chronic conditions and more. [from publisher]

Pay for performance (P4P) is an innovative approach that explicitly links financial investment in health to health results. However, the mechanics of its implementation need to be planned very carefully to elicit the desired behavior change in a given country. This guide offers the reader a systematic framework to document and structure a P4P initiative. [adapted from foreword]

This paper presents data on the remittances sent by migrant nurses to their families back home. It gives voice to the experiences of migrant nurses and illustrates the financial obligations they maintain while working overseas. [from abstract]

This article assesses the potential impact of financial incentives in alleviating health worker shortages in underserved areas through contracting future health workers to work for a number of years in an underserved area in exchange for a financial pay-off. [adapted from author]

Health worker shortages are one of the main constraints in achieving worldwide population health goals. Financial-incentive programs for return of service can alleviate local and regional health worker shortages through a number of mechanisms. This article draws on studies of financial-incentive programs and other initiatives with similar objectives to discuss management functions that are essential for the long-term success of financial-incentive programmes. [adapted from abstract]

There is growing evidence that informal payments for health care are fairly common in many low- and middle-income countries. Informal payments are reported to have a negative consequence on equity and quality of care; it has been suggested, however, that they may contribute to health worker motivation and retention. This study suggests that the practice of informal payments contributes to the general demotivation of health workers and negatively affects access to health care services and quality of the health system. [adapted from abstract]

Nepal’s Safe Delivery Incentive Programme (SDIP) was introduced nationwide in 2005 with the intention of increasing utilisation of professional care at childbirth. It provided cash to women giving birth in a health facility and an incentive to the health provider for each delivery attended, either at home or in the facility. We explored early implementation of the programme at the district-level to understand the factors that have contributed to its low uptake. [from abstract]

This video, produced by the Center for Global Development, outlines the case for a new metthod of disbursing donor contributions for global health called Performance-Based Incentives (PBI). PBI aims to boost global health by basing donor contributions on performance and permitting developing countries health systems to determine how to disburse these incentives. [from publisher]

Rwanda is one of the pioneers of performance-based financing. Building on lessons from three donor-financed pilots, the government has assumed leadership for this approach and is scaling up a standardized model nationwide. [from author]

This study undertook an in-depth exploration of the unintended consequences of pay-for-performance programs In England and California. The authors interviewed primary care physicians in California and England and compared unintended consequences in each setting. [adapted from abstract]

This article describes the issues facing Uganda’s health system and presents arguments for and against instituting a performance-based pay system.

Since the early 1990s Indonesia has attempted to increase the level of skilled attendance at birth by placing rural midwives in every village in an effort to reduce persistently high levels of maternal mortality. Yet evidence suggests that there remains insufficient incentive to ensure an equal distribution across areas while the poor in all areas continue to access skilled attendance much less than those in richer groups.

The current global tuberculosis (TB) epidemic has pressured health care managers, particularly in developing countries, to seek for alternative, innovative ways of delivering effective treatment to the large number of TB patients diagnosed annually. One strategy employed is direct observation of treatment for all patients. In high-burden settings innovation with this strategy has resulted into the use of lay community members to supervise TB patients during the duration of anti-TB treatment.

Incentives such as P4P can be very powerful in their effects. Caution in their design and deployment is essential. However, ignoring their potential would be unwise, as they offer the possibility of improving value for money for taxpayers and patients. The first section of the paper will review evidence of common provider problems in all health care systems and their implications for introducing a P4P system. This will be followed by a review of P4P reforms in the United Kingdom and United States in particular. [from author]

This study reviews the healthcare literature that examines the effect of financial incentives on the behaviour of healthcare organisations and individuals with respect to the quality of care they deliver to consumers. Its purpose is to provide guidance to policy-makers in government and decision-makers in the private sector in their efforts to improve quality of care through payment reforms. [adapted from summary]

The original purpose of the ADHA scheme was to compensate doctors for hours worked beyond the standard 40 hours per week or 160 hours per month. This study investigated how the scheme impacted a number of human resources (HR) factors associated with health worker recruitment, deployment, retention and performance - specifically, how the significantly higher income levels resulting from the ADHA scheme influenced job satisfaction, motivation, workplace climate and the relationship between clinical and administrative staff, as well as productivity. The study provides a detailed chronology of the ADHA scheme and explores lessons learned from the way in which the GOG implemented and administered the scheme.

This presentation was given at the First Forum on Human Resources for Health in Kampala. It reviews a study of how Rwanda, faced with constrained fiscal conditions, has implemented innovative reforms to create fiscal space for human resources and to make these resources more responsive to needs through an analysis of budget documents and policy and regulation changes and key informant interviews. [adapted from author]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It describes a study done to analyze health worker perceptions of renumeration and determine the factors that affect the mobility of the health workforce in Burkina Faso

The aim of the project was to evaluate the effect of the new rural allowance on the short-term career choices of health professionals in rural areas. A longitudinal cohort study design was used, before and after the introduction of the new allowance.

This presentation was given as part of the Christian Health Association’s Conference: CHAs at a Crossroad Towards Achieving Health Millennium Development Goals. It discusses the human resources for health situation in Tanzania in general, and specific findings from the Lake zone in terms of health workers in church health institutions. The author proposes options for a motivation package to address the issues of retention for these workers.

Provider payment methods are important to consider any time a government or a payor wants to improve the efficiency and the quality of health services with the use of its funds. Changes in provider payment methods are often pivotal to broader health reform measures to contain costs and use existing resources effectively, and also to improve quality of care and equitable financial access to care. [author’s description]

This resolution, enacted by the Department of Health in South Africa, details the management and conditions of an allowance designed to attract and retain health workers in rural areas.