Looking into the performance-based financing black box: evidence from an impact evaluation in the health sector in Cameroon
Looking into the performance-based financing black box: evidence from an impact evaluation in the health sector in Cameroon
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DOI：
10.1093/heapol/czab002
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发表时间：
2021-05-08
影响因子：
3.2
通讯作者：
Steenland, Maria
中科院分区：
文献类型：
--
作者：
de Walque, Damien;Robyn, Paul Jacob;Steenland, Maria
绩效融资（PBF）是一项复杂的卫生系统干预措施，旨在提高医疗服务的覆盖面和质量。几项研究表明，PBF对保健服务覆盖面产生了积极影响，通常还伴随着质量的提高，但对推动这些结果的机制知之甚少。本文介绍了在喀麦隆进行的一项随机影响评估的结果，该评估旨在通过四个研究组分离PBF方法的特定组成部分的作用：(i) PBF与结果挂钩的明确财政激励，（ii）向卫生提供者提供与绩效无关的额外资源的直接融资，（iii）在没有额外资源的情况下加强监督和监测，以及（iv）一个对照组。总体而言，结果表明，与纯对照组相比，喀麦隆的PBF导致多项服务（儿童和孕产妇疫苗接种，现代计划生育的使用）的利用率显著提高，但其他服务（如产前保健访问和基于设施的分娩）的利用率没有提高。在质量方面，PBF增加了投入和设备、合格卫生工作者的可用性，导致了正式和非正式用户费用的减少，但没有影响到护理的内容。然而，对于许多积极影响的结果来说，PBF组和接受额外融资的组之间的差异并不显著，这表明额外的资金而不是明确的激励可能是推动改善的原因。相比之下，在没有额外资金的情况下，提供加强监督、指导和监测的干预组与对照组相比没有明显的影响。
Performance-based financing (PBF) is a complex health systems intervention aimed at improving the coverage and quality of care. Several studies have shown a positive impact of PBF on health service coverage, often coupled with improvements in quality, but relatively little is known about the mechanisms driving those results. This article presents results of a randomized impact evaluation in Cameroon designed to isolate the role of specific components of the PBF approach with four study groups: (i) PBF with explicit financial incentives linked to results, (ii) direct financing with additional resources available for health providers not linked to performance, (iii) enhanced supervision and monitoring without additional resources and (iv) a control group. Overall, results indicate that, when compared with the pure control group, PBF in Cameroon led to significant increases in utilization for several services (child and maternal vaccinations, use of modern family planning), but not for others like antenatal care visits and facility-based deliveries. In terms of quality, PBF increased the availability of inputs and equipment, qualified health workers, led to a reduction in formal and informal user fees but did not affect the content of care. However, for many positively impacted outcomes, the differences between the PBF group and the group receiving additional financing not linked to performance are not significant, suggesting that additional funding rather than the explicit incentives might be driving improvements. In contrast, the intervention group offering enhanced supervision, coaching and monitoring without additional funding did not experience significant impacts compared to the control group.