Using Provider Performance Incentives to Increase HIV Testing and Counseling Services in Rwanda
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World Bank, Washington, DC
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Paying for performance provides
financial rewards to medical care providers for improvements
in performance measured by specific utilization and quality
of care indicators. In 2006, Rwanda began a paying for
performance scheme to improve health services delivery,
including HIV/AIDS services. This study examines the
scheme's impact on individual and couples HIV testing
and counseling and using data from a prospective
quasi-experimental design. The study finds a positive impact
of paying for performance with an increase of 6.1 percentage
points in the probability of individuals having ever been
tested. This positive impact is stronger for married
individuals: 10.2 percentage points. The results also
indicate larger impacts of paying for performance on the
likelihood that the respondent reports both partners have
ever been tested, especially among discordant couples (14.7
percentage point increase) in which only one of the partners
is HIV positive.
Palabras clave
AGED, AIDS EPIDEMIC, AIDS PATIENTS, ANAEMIA, ANEMIA, BEHAVIORAL RISK, BG, BULLETIN, BURNS, CAPACITY BUILDING, CHILD HEALTH, CHILD HEALTH SERVICES, CONTRACEPTION, COUNSELING, DEATHS, DEVELOPING COUNTRIES, DEVELOPMENT ASSISTANCE, DEVELOPMENT POLICY, DISSEMINATION, EPIDEMIC, EPIDEMICS, EXPENDITURES, FINANCIAL MANAGEMENT, GLOBAL DEVELOPMENT, GLOBAL HEALTH, GLOBAL POPULATION, HEALTH CARE, HEALTH CARE PROVISION, HEALTH CENTERS, HEALTH FACILITIES, HEALTH INTERVENTIONS, HEALTH OUTCOMES, HEALTH PROVIDERS, HEALTH SECTOR, HEALTH SECTOR REFORM, HEALTH SERVICES, HEALTH SERVICES RESEARCH, HEALTH SYSTEM, HEALTH SYSTEM PERFORMANCE, HEALTH-CARE PROVIDERS, HIV, HIV INFECTIONS, HIV POSITIVE, HIV PREVENTION, HIV TESTING, HIV TRANSMISSION, HIV/AIDS, HOSPITAL, HOSPITALS, HOUSEHOLD ASSETS, HOUSEHOLD LEVEL, HOUSEHOLD SURVEYS, HUMAN DEVELOPMENT, HUMAN IMMUNODEFICIENCY VIRUS, IMMUNE DEFICIENCY, IMMUNE DEFICIENCY SYNDROMES, IMMUNIZATION, IMMUNODEFICIENCY, INCOME, INDIVIDUAL CHARACTERISTICS, INFANTS, INFECTION, INFORMED CONSENT, INTERVENTION, JOURNAL OF MEDICINE, LABOR SUPPLY, MALARIA, MANAGEMENT SYSTEMS, MARITAL STATUS, MATERNAL AND CHILD HEALTH, MEDICAL CARE, MEDICAL PERSONNEL, MEDICAL SUPPLIES, MEDICINE, MILLENNIUM DEVELOPMENT GOALS, MINISTRY OF HEALTH, MOTHER, MOTHER-TO-CHILD, MOTHER-TO-CHILD TRANSMISSION, MS, NATIONAL AIDS, NATIONAL AIDS CONTROL, NUMBER OF COUPLES, PARTNER TESTING, PATIENT, PATIENTS, PHYSICIAN, PHYSICIANS, POLICY DISCUSSIONS, POLICY RESEARCH, POLICY RESEARCH WORKING PAPER, POPULATION DENSITY, PREGNANT WOMEN, PRENATAL CARE, PREVALENCE, PREVENTION OF MOTHER-TO-CHILD TRANSMISSION, PRIMARY CARE, PRIMARY HEALTH-CARE, PROBABILITY, PROGRESS, PROVIDER INCENTIVES, PUBLIC HEALTH, PUBLIC SERVICES, QUALITY OF CARE, QUALITY OF HEALTH, QUALITY OF HEALTH CARE, RESPECT, RISK REDUCTION, SERVICE DELIVERY, SERVICE PROVISION, SEX, SEXUAL ACTIVITY, SEXUAL BEHAVIOR, SEXUAL PARTNER, SEXUAL PARTNERS, SEXUALLY ACTIVE, SOCIAL RESEARCH, SOCIAL SCIENCE, SYNDROMES, TB, THERAPY, TREATMENT, TUBERCULOSIS, UNAIDS, UNINFECTED PARTNER, UNIVERSAL ACCESS, VIRUS, VOLUNTARY COUNSELING, WORLD HEALTH ORGANIZATION, YOUNG CHILDREN