What happens when performance-based financing meets free healthcare? Evidence from an interrupted time-series analysis
What happens when performance-based financing meets free healthcare? Evidence from an interrupted time-series analysis
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DOI：
10.1093/heapol/czaa062
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发表时间：
2020-10-01
影响因子：
3.2
通讯作者：
De Allegri, Manuela
中科院分区：
文献类型：
--
作者：
Kuunibe, Naasegnibe;Lohmann, Julia;De Allegri, Manuela
尽管基于绩效的筹资在过去十年中受到广泛关注，但没有证据表明其对服务提供的数量和组合的影响，也没有证据表明其与平行卫生筹资干预措施的相互作用。我们的研究旨在研究PBF对布基纳法索服务提供的数量和组合的影响，同时考虑到免费医疗政策的并行引入。我们使用了来自24个地区838个初级卫生设施的健康管理信息系统数据，并依赖于独立控制的中断时间序列分析。我们设置了两个中断，一个是PBF，另一个是免费医疗政策。在实行免费保健政策之前，PBF在广泛的妇幼服务方面产生了显著但适度的增长，但儿童免疫接种覆盖率大幅下降。在引入免费医疗政策后的一段时间内，PBF并没有影响干预服务的提供相比，控制设施，可能表明饱和效应。我们的研究结果表明，PBF可以在不改变整体服务组合的情况下，适度增加服务提供。然而，我们的研究结果也表明，引入其他卫生筹资改革可以迅速挤出PBF产生的影响。需要进一步的定性研究，以了解哪些因素允许医疗保健提供者增加提供一些，但不是所有的服务，以及他们如何应对PBF和免费医疗的联合实施。
In spite of the wide attention performance-based financing (PBF) has received over the past decade, no evidence is available on its impacts on quantity and mix of service provision nor on its interaction with parallel health financing interventions. Our study aimed to examine the PBF impact on quantity and mix of service provision in Burkina Faso, while accounting for the parallel introduction of a free healthcare policy. We used Health Management Information System data from 838 primary-level health facilities across 24 districts and relied on an interrupted time-series analysis with independent controls. We placed two interruptions, one to account for PBF and one to account for the free healthcare policy. In the period before the free healthcare policy, PBF produced significant but modest increases across a wide range of maternal and child services, but a significant decrease in child immunization coverage. In the period after the introduction of the free healthcare policy, PBF did not affect service provision in intervention compared with control facilities, possibly indicating a saturation effect. Our findings indicate that PBF can produce modest increases in service provision, without altering the overall service mix. Our findings, however, also indicate that the introduction of other health financing reforms can quickly crowd out the effects produced by PBF. Further qualitative research is required to understand what factors allow healthcare providers to increase the provision of some, but not all services and how they react to the joint implementation of PBF and free health care.