Long-term effects of payment for performance on maternal and child health outcomes: evidence from Tanzania.
Long-term effects of payment for performance on maternal and child health outcomes: evidence from Tanzania.
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DOI：
10.1136/bmjgh-2021-006409
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发表时间：
2021-12
影响因子：
8.1
通讯作者：
Maestad O
中科院分区：
文献类型：
--
作者：
Borghi J;Binyaruka P;Mayumana I;Lange S;Somville V;Maestad O
绩效付费（P4P）计划的成功取决于其对医疗服务提供者行为产生可持续变化的能力。本文探讨了坦桑尼亚P4P的短期和长期影响以及这些变化的原因。我们进行了一项前后对照研究和一项嵌入式过程评估。三轮设施，病人和家庭调查数据（基线，13个月后和36个月）测量方案在7个干预区和4个比较区的效果。我们使用线性差中差回归分析，以确定程序的影响，并随着时间的推移的差异效应。四轮质量数据审查了方案设计、执行和变革机制的演变情况。方案对产前保健期间住院分娩率和抗疟治疗的影响减少了超时工作，抗疟药物的缺货率随着时间的推移增加到基线水平。P4P导致分娩过程中的善意持续改善，从长远来看，患者的护理体验得到了更广泛的改善。方案管理和供资方面的变化推迟了奖励金的支付，影响了一些指标的执行情况。随着时间的推移，核查系统越来越多地融入日常系统，减少了管理人员和卫生工作者的时间负担。持续的财务自主和监督在不依赖资金的护理方面产生了持续的激励作用。我们的研究增加了有限和混合的证据，记录了P4P效应如何随着时间的推移而演变。我们的研究结果强调了随着时间的推移进行持续评估的重要性。
The success of payment for performance (P4P) schemes relies on their ability to generate sustainable changes in the behaviour of healthcare providers. This paper examines short-term and longer-term effects of P4P in Tanzania and the reasons for these changes. We conducted a controlled before and after study and an embedded process evaluation. Three rounds of facility, patient and household survey data (at baseline, after 13 months and at 36 months) measured programme effects in seven intervention districts and four comparison districts. We used linear difference-in-difference regression analysis to determine programme effects, and differential effects over time. Four rounds of qualitative data examined evolution in programme design, implementation and mechanisms of change. Programme effects on the rate of institutional deliveries and antimalarial treatment during antenatal care reduced overtime, with stock out rates of antimalarials increasing over time to baseline levels. P4P led to sustained improvements in kindness during deliveries, with a wider set of improvements in patient experience of care in the longer term. A change in programme management and funding delayed incentive payments affecting performance on some indicators. The verification system became more integrated within routine systems over time, reducing the time burden on managers and health workers. Ongoing financial autonomy and supervision sustained motivational effects in those aspects of care giving not reliant on funding. Our study adds to limited and mixed evidence documenting how P4P effects evolve over time. Our findings highlight the importance of undertaking ongoing assessment of effects over time.
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影响因子：
4.4
作者：
Eijkenaar, Frank
通讯作者：
Eijkenaar, Frank
影响因子：
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