The Impact of a Pay-for-Performance Scheme on Prescription Quality in Rural China : Impact Evaluation
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World Bank, Washington, DC
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In China, health care providers have
traditionally been paid fee-for-service and overprescribing
and high out-of-pocket spending are common. In this study,
township health centers in two counties were assigned almost
randomly to two groups: in one, fee-for-service was replaced
by a global capitated budget; in the other, by a mix of
global capitated budget and pay-for-performance. Performance
captured inter alia "irrational" drug prescribing;
20 percent of the global capitated budget was withheld each
quarter, points were deducted for failure to meet targets,
and some of the withheld budget was returned in line with
the points deducted. Outcomes included appropriate
prescribing and prescription cost, data on which were
obtained by digitizing prescriptions from a month just
before the reform and from the same month a year later.
Impacts were assessed via multivariate
differences-in-differences with township health center fixed
effects. To reduce bias from non-randomness in assignment,
the sample was trimmed by coarsened exact matching.
Pay-for-performance reduced inappropriate prescribing
significantly and substantially in the county where the
initial level was above the penalty threshold, but end-line
rates were still appreciable; no effects were seen in the
county where initial levels were around or below the
threshold, or on out-of-pocket spending in either county.
Palabras clave
ANTENATAL CARE, CAPITATION, CENTER FOR HEALTH, CHILD HEALTH, CHILD HEALTH SERVICES, CHRONIC ILLNESSES, CITIES, CLINICAL PATHWAYS, CLINICS, DEVELOPMENT POLICY, DIAGNOSIS, DOCTORS, DRUG RESISTANCE, EARLY YEARS, ESSENTIAL DRUGS, FAMILIES, FEE-FOR-SERVICE, HEALTH CARE, HEALTH CARE FACILITIES, HEALTH CARE PROVIDER, HEALTH CARE PROVIDERS, HEALTH CENTERS, HEALTH CLINICS, HEALTH COVERAGE, HEALTH ECONOMICS, HEALTH INSURANCE, HEALTH INTERVENTIONS, HEALTH MANAGEMENT, HEALTH ORGANIZATION, HEALTH POLICY, HEALTH SERVICES, HEALTH SYSTEM, HEALTH SYSTEMS, HEALTH-CARE PROVIDERS, HEALTHCARE, HEALTHCARE PROVIDERS, HOSPITAL, HOSPITAL MANAGEMENT, HOSPITALS, HUMAN DEVELOPMENT, HYGIENE, ILLNESS, IMMUNIZATION, INCOME, INSURANCE, INSURANCE COVERAGE, INSURANCE SCHEMES, INTERVENTION, LOCAL GOVERNMENTS, MATERNAL AND CHILD HEALTH, MEDICAL COLLEGE, MEDICAL STAFF, MEDICINE, MEDICINES, MIGRANT, MIGRANT WORKERS, MINISTRY OF HEALTH, MISUNDERSTANDING, NEGATIVE EFFECTS, NUMBER OF PEOPLE, OUTPATIENT SERVICES, PATIENT, PATIENT SATISFACTION, PATIENTS, PHYSICAL ENVIRONMENT, PHYSICIANS, POLICY ANALYSIS, POLICY DISCUSSIONS, POLICY GOALS, POLICY MAKERS, POLICY RESEARCH, POLICY RESEARCH WORKING PAPER, POPULATION SIZE, PRESCRIPTIONS, PREVENTIVE CARE, PRIMARY CARE, PRIMARY HEALTH CARE, PRIMARY HEALTH CARE FACILITIES, PRIMARY HEALTH-CARE, PROGRESS, PROVIDER PAYMENT, PROVISION OF CARE, PUBLIC POLICY, PUBLIC SERVICES, QUALITY OF CARE, RURAL HOSPITALS, RURAL POPULATION, RURAL RESIDENTS, SERVICE PROVIDERS, SOCIAL HEALTH INSURANCE, SOCIAL SCIENCE, TECHNICAL SKILLS, TREATMENT, VISITS, WAR, WORKERS, WORLD HEALTH ORGANIZATION