Paying for Performance and CE of Strategies to Combat Anemia in China

描述（由申请人提供）：对有限的全球卫生项目有效性的一个重要解释是行为障碍，这些障碍在卫生技术的实验室效率和它们在现实世界项目中的有效性之间造成了隔阂。创新的新合同形式通过奖励提供者（供应方）和消费者（需求方）以实现良好的健康结果等最终社会目标来解决这些行为障碍，因此可能在发展中国家产生巨大的健康收益。然而，在实践中，它们的实际益处缺乏严格的证据。拟议中的项目将比以往的绩效薪酬激励研究取得几项重要进展。首先，来自少数高质量研究的现有证据对绩效薪酬激励的全部前景提供了有限的见解，因为它们奖励的是使用特定的健康投入，而不是实际的健康改善。直接奖励健康成果（正如我们提议的那样）可以更有力地激励提供者和消费者利用当地信息制定创新的新的健康改善战略，而不必严格规定他们应该如何这样做。其次，尽管对需求侧激励的影响的了解最近有所增加，但没有证据表明它们相对于供给侧激励的相对有效性（和成本效益）。第三，需求侧和供给侧激励是净替代还是互补——这是政策制定者将不同干预措施结合成大规模健康改善战略的一个关键问题——是完全未知的。为了提供关于如何更好地将供给侧激励与良好的人口健康结合起来的新证据，并评估其相对有效性以及与需求侧激励的潜在协同作用，我们建议在中国农村进行一项大规模随机政策实验。我们的重点是为小学校长和学生家长提供减少贫血的奖励。我们的项目是我们所知道的第一个直接奖励健康成果的项目，鉴于中国政府目前的兴趣，它有可能产生立竿见影的影响。为此，我们提出了六个具体目标：(1)提供中国农村小学适龄儿童贫血患病率的新估计；(2)分析中国贫困农村小学教育工作者（校长）对减少贫血的绩效薪酬奖励的行为反应及其净健康后果；(3)估计父母对子女的私人卫生投资对公共卫生干预措施的反应；(4)研究供给侧和需求侧激励措施对减少贫血的比较有效性，并评估它们是净补充还是替代；(5)计算减少贫血的供给侧和需求侧方法的成本效益；(6)创建一个新的、公开的中国农村儿童及其学校数据集。

DESCRIPTION (provided by applicant): An important explanation for limited global health program effectiveness is behavioral obstacles that drive a wedge between the laboratory efficacy of health technologies and their effectiveness in real-world programs. Innovative new forms of contracting that address these behavioral obstacles by rewarding both providers (on the supply-side) and consumers (on the demand-side) for ultimate social objectives like good health outcomes may therefore produce large health gains in developing countries. There is a paucity of rigorous evidence on their actual benefits in practice, however. The proposed project will produce several important advances over previous studies of pay-for- performance incentives. First, existing evidence from the handful of good-quality studies provides limited insight into the full promise of pay-for-performance incentives because they reward the use of specific health inputs rather than actual health improvement. Rewarding health outcomes directly (as we propose to do) provides stronger incentives for providers and consumers to use local information to develop innovative new health improvement strategies without rigidly prescribing about how they should do so. Second, although knowledge about the impact of demand-side incentives has recently grown, there is no evidence on their comparative effectiveness (and cost-effectiveness) relative to supply-side incentives. Third, whether or not demand- and supply-side incentives are net substitutes or complements - a key question for policymakers combining different interventions into large-scale health improvement strategies - is completely unknown. To provide new evidence on how better to align supply-side incentives with good population health and to assess their comparative effectiveness and potential synergies with demand-side incentives, we propose to conduct a large-scale randomized policy experiment in rural China. Our specific focus is the provision of incentives for reducing anemia to primary school principals and the parents of their students. Our project is the first of which we are aware that directly rewards health outcomes, and it holds the potential for immediate impact given current interest from China's government. In doing so, we propose six specific aims: (1) To provide new estimates of anemia prevalence among primary school age children in rural China; (2) To analyze the behavioral responses of educators (principals) in poor rural primary schools in China to pay-for-performance rewards for reducing anemia - and their net health consequences; (3) To estimate how private health investments that parents make in their children respond to public health interventions; (4) To study the comparative effectiveness of supply- and demand-side incentives for anemia reduction and to assess whether or not they are net complements or substitutes; (5) To calculate the cost-effectiveness of supply- and demand-side approaches for anemia reduction; and (6) To create a new, publicly available dataset of rural Chinese children and their schools.