Studying the link between institutions and health system performance: a framework and an illustration with the analysis of two performance-based financing schemes in Burundi
Studying the link between institutions and health system performance: a framework and an illustration with the analysis of two performance-based financing schemes in Burundi
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DOI：
10.1093/heapol/czs124
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发表时间：
2013-12-01
影响因子：
3.2
通讯作者：
Meessen, Bruno
中科院分区：
文献类型：
--
作者：
Bertone, Maria Paola;Meessen, Bruno
越来越多的人认识到，卫生系统的体制安排及其制定的激励措施对于促进或阻碍卫生部门的业绩至关重要。从机构的角度看待复杂的卫生系统干预措施可能有助于更好地理解导致此类干预措施结果的途径和过程。在本文中，我们提出了一个借鉴新制度经济学的分析框架。这一框架建议考察七个方面：制度、执行机制、产权、激励、外在和内在动机来源之间的相互作用、行为变化和组织绩效。为了说明起见，我们将该框架用于分析布隆迪两个基于绩效的融资计划的体制(再)安排，方法是进行案例研究的经验比较。我们主要使用来自一手和二手来源的定性数据，并重点分析该框架的七个方面。对案例研究的分析提供了两个建设和平基金计划的对比说明，并突出说明了它们在业务设计、执行过程中面临的挑战和作出的调整方面的不同。从方法论的角度，本文提出了一种分析复杂卫生系统干预措施的工具，不仅着眼于对最终效果的评估，还着眼于体制(重新)安排通过哪些过程影响这些结果。它的应用表明，在经验层面上，这种分析可以帮助确定关于设计卫生系统干预措施的经验教训，例如建设和平基金计划，以及改革体制安排的进程。
Institutional arrangements of health systems and the incentives they set are increasingly recognized as critical to promote or hinder performance in the health sector. Looking at complex health system interventions from an institutional perspective may contribute to better understanding what are the paths and processes that lead to the results of such interventions. In this article, we propose an analytical framework drawing from new institutional economics. This framework suggests seven dimensions to look at: institutions, enforcement mechanisms, property rights, incentives, interactions between extrinsic and intrinsic sources of motivation, behavioural changes and organizational performance. For illustrative purposes, we then apply the framework to the analysis of the institutional (re)arrangements of two performance-based financing (PBF) schemes in Burundi by carrying out an empirical comparison of case studies. We use mainly qualitative data from primary and secondary sources and analyse them with focus on the seven dimensions of the framework. The analysis of the case studies provides a comparative narrative of the two PBF schemes and highlights the differences in their operational design, the challenges faced during implementation and the adaptations made. From a methodological perspective, this article proposes a tool to analyse complex health system interventions, looking beyond the evaluation of the final effects to focus on the processes through which institutional (re)arrangements affected those results. Its application indicates, at an empirical level, that such analysis could help identify lessons regarding the design of health systems interventions, such as PBF schemes, and the process of reforming institutional arrangements.