Can performance-based financing help reaching the poor with maternal and child health services? The experience of rural Rwanda
Can performance-based financing help reaching the poor with maternal and child health services? The experience of rural Rwanda
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DOI：
10.1002/hpm.2297
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发表时间：
2016-07-01
影响因子：
2.7
通讯作者：
Basinga, Paulin
中科院分区：
文献类型：
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作者：
Lannes, Laurence;Meessen, Bruno;Basinga, Paulin
20多个非洲国家正在扩大基于绩效的融资，但其对公平获得卫生服务的影响仍有待记录。本文借鉴卢旺达的证据，以审查PBF的能力，以确保平等获得关键的卫生干预措施，特别是在农村地区，大多数穷人生活。具体而言，它侧重于孕产妇和儿童健康服务，区分两个财富群体，并使用来自严格影响评估的数据。使用差分技术，并测试不同的模型规格：控制未观察到的异质性和共同的随机误差，使用线性概率模型，看似无关的回归方程，聚类和固定效应。结果表明，在卢旺达，建设和平基金提高了大多数保健服务的效率，而不是公平。我们发现，PBF通过改善那些更容易接触到的人（通常是相对较富裕的人）获得卫生服务的机会，实现了效率的提高。事实证明，它在帮助最贫穷的人方面效果较差。我们的研究结果说明了严格的随机影响评估数据的优势，因为早期发表的结果使用全国代表性的调查（人口与健康调查）无法捕捉亲丰富的性质PBF计划在Rwanda.Our文件倡导建立机制，针对弱势群体的PBF战略。报告还强调，需要了解建设和平基金的影响，以及医疗保险覆盖面和卫生系统组织的具体发展情况。
More than 20 countries in Africa are scaling up performance-based financing (PBF), but its impact on equity in access to health services remains to be documented. This paper draws on evidence from Rwanda to examine the capacity of PBF to ensure equal access to key health interventions especially in rural areas where most of the poor live. Specifically, it focuses on maternal and child health services, distinguishing two wealth groups, and uses data from a rigorous impact evaluation.Difference-in-difference technique is used, and different model specifications are tested: control for unobserved heterogeneity and common random error using linear probability model, seemingly unrelated regression equations, and clustering and fixed effects.Results suggest that in Rwanda, PBF improved efficiency rather than equity for most health services. We find that PBF achieved efficiency gains by improving access to health services for those easier to reach, generally the relatively more affluent. It turns out to be less effective in reaching the poorest. Our results illustrate the advantages of rigorous randomized impact evaluation data as results published earlier using a nationally representative survey (Demographic and Health Survey) were not able to capture the pro-rich nature of the PBF scheme in Rwanda.Our paper advocates for building mechanisms targeting the vulnerable groups in PBF strategies. It also highlights the need to understand the impact of PBF together with the specific development of health insurance coverage and the organization of the health system.