Understanding the experience, preferences and effects of provider payment mechanisms in Tanzania

低收入和中等收入国家的许多卫生系统通过多种来源(税收、保险、捐助者支助)提供资金，而提供者则通过多种方式(如按人头付费、服务费、工资)支付费用。因此，卫生服务提供者面临着资金的多重流动，每个来源都有不同的支付方式。由于供应商可能会根据所面对的支付方式做出不同的反应，因此重要的是实施一种将刺激供应商的生产率提高并将意外反应降至最低的支付方法。与其他发展中国家一样，坦桑尼亚目前正计划协调卫生筹资来源(通过引入单一的国家医疗保险)，并使用统一/统一的医疗服务提供者支付机制。协调资金来源和统一的医疗服务提供者支付机制是实现全民健康覆盖的关键步骤。因此，在这项研究中，我建议更好地了解提供商对提供商支付机制的体验、反应和偏好，并确定每种支付方式对服务质量、覆盖范围和公平性的影响。了解他们如何看待可用的支付方式，他们如何做出不同的反应，以及他们最喜欢哪些属性。此外，了解不同的提供商对服务质量、覆盖率和公平性的反应。这项研究还将产生与政策相关的建议，以便为坦桑尼亚正在进行的规划设计最佳和可行的提供者支付机制提供参考。这一发现可能仍然适用于其他计划改革供应商支付机制的环境。了解提供商在支付方式属性方面最喜欢哪种支付方式，将有助于设计一种易于被提供商接受的支付方式，并做出积极回应，以改善服务交付。研究问题将通过使用定性和定量数据的多个数据来源来解决。数据将收集来自健康提供者、患者、健康购买者和政策制定者的观点和信息。量化数据将来自两个区的120名退出护理的患者和来自六个区的240名卫生工作者，这些人获得了偏好。将举办一次“以行动为基础”的传播研讨会，为主要利益攸关方提供机会，反思关键结果、制定优先事项和计划，以便在坦桑尼亚以最佳方式设计实践、可行和有效的供应商支付方法。

Many health systems in low and middle income countries (LMICs) have are financing through multiple sources (taxes, insurance, donor support) and providers are paid through multiple methods (e.g. capitation, fee-for-service, salary). So, health providers are faced with multiple flow of funds, and each source has a different payment modality. Since providers can respond differently depending on which payment method are facing, it is important to implement a payment method that will stimulate providers' productivity to increase and minimise unintended responses. Tanzania, like other developing countries, is currently planning to harmonise the health financing sources (by introducing a single national health insurance) and use a harmonised/ unified provider payment mechanism. The harmonisation of funding sources and unified provider payment mechanisms are key steps towards universal health coverage. In this study, therefore, I propose to better understand providers experience, responses, and preferences for provider payment mechanisms, and also identify the effect of each payment method on service quality, coverage and equity. To know how they perceive available payment methods, how they respond differently, and which attributes they prefer most. Also, to know the varied provider responses to service quality, coverage and equity. This study will also generate policy-relevant recommendation to inform the ongoing planning of designing optimal and feasible provider payment mechanisms in Tanzania. The findings might still be relevant to other settings planning to reform their provider payment mechanisms. Understanding what provider prefer most in terms of payment method attributes, will help design a payment method that can easily be acceptable among providers and response positively to improve service delivery.The research questions will be tackled through multiple sources of data using both qualitative and quantitative data. Data will capture the perspectives and information from health providers, patients, health purchasers, and policy makers. Quantitative data will come from 120 patients exiting care from 2 districts and 240 health workers from 6 districts eliciting the preferences. An 'action-based' dissemination workshop will be conducted to provide key stakeholders with an opportunity to reflect on the key findings, develop priorities, and plans to optimally design practice, feasible and efficient provider payment methods in Tanzania.