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

描述（由申请人提供）：全球卫生项目有效性有限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有效性与其在现实世界项目中的有效性之间形成了一个楔子。因此，通过奖励提供者（在供应方）和消费者（在需求方）实现诸如良好健康结果等最终社会目标来解决这些行为障碍的创新性新合同形式可能会在发展中国家产生巨大的健康收益。然而，缺乏关于其实际效益的有力证据。 拟议的项目将产生几个重要的进步，比以前的研究按业绩计薪奖励。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承诺提供了有限的见解，因为它们奖励使用特定的健康投入，而不是实际的健康改善。直接奖励健康结果（正如我们所建议的那样）为供应商和消费者提供了更强的激励，使他们能够利用当地信息制定创新的新健康改善策略，而不必硬性规定他们应该如何做。第二，虽然最近对需求方激励措施的影响有了更多的了解，但没有证据表明其相对于供应方激励措施的相对有效性（和成本效益）。第三，需求方和供应方激励是净替代还是补充--这是决策者将不同干预措施纳入大规模健康改善战略的关键问题--完全未知。 为了提供新的证据，说明如何更好地将供给侧激励与良好的人口健康相结合，并评估其相对有效性和与需求侧激励的潜在协同作用，我们建议在中国农村进行大规模的随机政策实验。我们的具体重点是向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，它有可能立即产生影响。本研究提出了六个具体目标：（1）提供中国农村小学学龄儿童贫血患病率的新估计;（2）分析教育工作者的行为反应（校长）在中国贫困的农村小学，以支付绩效奖励减少贫血-及其净健康后果;（3）估计父母对子女的私人保健投资如何对公共保健干预作出反应;（4）研究供应和需求的相对有效性，（5）计算供应方和需求方减少贫血的成本效益;（6）建立一个新的、公开可用的中国农村儿童及其学校的数据集。

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.