A preliminary assessment of financial stability, efficiency, health systems and health outcomes using performance-based contracts in Belize

Bowser, Diana; Figueroa, Ramón; Natiq, Laila; Okunogbe, Adeyemi

doi:10.1080/17441692.2013.829511

Cited by 13 publications

(9 citation statements)

References 10 publications

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“… Are there potential conflicts of interest? Bowser (2013) [ 19 ] No Status quo (traditional salaries and line-item budgets). 2006 to 2010 No clear description of the included and omitted costs.…”

Section: Resultsmentioning

confidence: 99%

“…The seven articles examined the impact of PBF programs over different time periods. Gok & Altmdag [ 18 ]’s study ranges from 2001–2008; Bowser et al [ 19 ] and Sabri et al [ 20 ]’s study cover a four-year time period; and Zeng et al [ 21 ], Basinga et al [ 16 ], Rusa et al [ 22 ], and Soeters et al [ 23 ] report change over a two year period. From the studies in this review, little is known about how the relation between PBF costs and outcomes in LMICs evolves over the long term.…”

Section: Resultsmentioning

confidence: 99%

“…For example, six of the seven studies in this systematic review were not included in the Cochrane review. Three of the studies were published after the Cochrane authors conducted their search [ 18 , 19 , 21 ]. The three other studies included in this systematic review, but not in the Cochrane review, were published and available in time to be considered [ 20 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

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Does performance-based financing increase value for money in low- and middle- income countries? A systematic review

et al. 2016

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Governments of low- and middle-income countries (LMICs) are widely implementing performance-based financing (PBF) to improve healthcare services. However, it is unclear whether PBF provides good value for money compared to status quo or other interventions aimed at strengthening the healthcare system in LMICs. The objective of this systematic review is to identify and synthesize the existing literature that examines whether PBF represents an efficient manner of investing resources. We considered PBF to be efficient when improved care quality or quantity was achieved with equal or lower costs, or alternatively, when the same quality of care was achieved using less financial resources. A manual search of the reference lists of two recent systematic reviews on economic evaluations of PBF was conducted to identify articles that met our inclusion and exclusion criteria. Subsequently, a search strategy was developed with the help of a librarian. The following databases and search engines were used: PubMed, EconLit, Google Scholar and Google. Experts on economic evaluations were consulted for validation of the selected studies. A total of seven articles from five LMICs were selected for this review. We found the overall strength of the evidence to be weak. None of the articles were full economic evaluations; they did not make clear connections between the costs and effects of PBF. Only one study reported using a randomized controlled trial, but issues with the randomization procedure were reported. Important alternative interventions to strengthen the capacities of the healthcare system have not been considered. Few studies examined the costs and consequences of PBF in the long term. Important costs and consequences were omitted from the evaluations. Few LMICs are represented in the literature, despite wide implementation. Lastly, most articles had at least one author employed by an organization involved in the implementation of PBF, thereby resulting in potential conflicts of interest. Stronger empirical evidence on whether PBF represents good value for money in LMICs is needed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Does performance-based financing increase value for money in low- and middle- income countries? A systematic review

et al. 2016

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“…Health worker shortages are a commonly acknowledged problem in Africa but P4P can be expected to improve the supply of health workers. A study in Belize found an increase in nurse density resulting from a national health insurance scheme with inbuilt performance contracts [ 17 ]. Health workers low satisfaction with salaries and employment benefits has been reported in other studies undertaken in Tanzania [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Pay for performance: an analysis of the context of implementation in a pilot project in Tanzania

Olafsdottir

Mayumana

Mashasi

et al. 2014

BMC Health Serv Res

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BackgroundPay for performance schemes are increasingly being implemented in low income countries to improve health service coverage and quality. This paper describes the context within which a pay for performance programme was introduced in Tanzania and discusses the potential for pay for performance to address health system constraints to meeting targets.Method40 in-depth interviews and four focus group discussions were undertaken with health workers, and regional, district and facility managers. Data was collected on work environment characteristics and staff attitudes towards work in the first phase of the implementation of the pilot. A survey of 75 facilities and 101 health workers were carried out to examine facility resourcing, and health worker employment conditions and job satisfaction.ResultsFive contextual factors which affect the implementation of P4P were identified by health workers: salary and employment benefits; resource availability, including staff, medicines and functioning equipment; supervision; facility access to utilities; and community preferences. The results suggest that it is important to consider contextual issues when implementing pay for performance schemes in low income settings. It highlights the importance of basic infrastructures being in place, a minimum number of staff with appropriate education and skills as well as sufficient resources before implementing pay for performance.ConclusionHealth professionals working within a pay for performance scheme in Tanzania were concerned about challenges related to shortages of resources, limited supplies and unfavourable community preferences. The P4P scheme may provide the incentive and means to address certain constraints, in so far as they are within the control of providers and managers, however, other constraints will be harder to address.

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“…4 There are only a few in-country studies that have examined the impact on health outcomes from pay-for-performance in upper-middle-income countries. 11,56 The results from some high-income countries, like England, do suggest that pay-for-performance can have an impact on mortality in the hospital setting. 57 The significant impact of community-based health insurance on infant and under-five mortality and association with reduced maternal mortality is important and encouraging.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Demand- and Supply-Side Health Financing on Infant, Child, and Maternal Mortality in Low- and Middle-Income Countries

Bowser

Gupta

Nandakumar

2016

Health Systems & Reform

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Demand-and supply-side health financing programs that improve maternal and child health are being implemented more frequently; however, there is limited evidence estimating their impact on maternal, infant, and child mortality at the macro level. The purpose of the study was to determine the impact of four specific types of demand-and supply-side health financing programs on infant, child, and maternal mortality at the global level and by county income categories. The following four demand-and supply-side health financing programs were chosen for inclusion in the analysis: conditional cash transfer programs, voucher programs, community-based health insurance, and pay-for-performance schemes. A fixed effects model was estimated, using panel data for 147 countries over the period 1995-2010, to measure the impact of these four demand-and supply-side health financing programs on infant, under-five, and maternal mortality. The model was estimated for all countries and for three country income categories: low, lower-middle, and upper-middle income. The implementation of demand-and supply-side health financing programs has increased over time, with 45 out of 147 countries in the data set implementing at least one of these programs by 2010. The results show that there is a significant decline in infant and under-five mortality from community-based health insurance when examined across all countries. There is also an impact from demand-and supply-side health financing when examined across the three country income classifications, with vouchers and pay-for-performance showing a varying impact on reduced infant, under-five, and maternal mortality depending on the country income classification. Health insurance schemes with a broad population reach, such as community-based health insurance, can have a large impact on infant and under-five mortality. Demand-and supplyside health financing programs, such as pay-for-performance and voucher programs, have a varying impact on infant, under-five, and maternal mortality depending on the income level of the country.

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A preliminary assessment of financial stability, efficiency, health systems and health outcomes using performance-based contracts in Belize

Cited by 13 publications

References 10 publications

Does performance-based financing increase value for money in low- and middle- income countries? A systematic review

Does performance-based financing increase value for money in low- and middle- income countries? A systematic review

Pay for performance: an analysis of the context of implementation in a pilot project in Tanzania

The Effect of Demand- and Supply-Side Health Financing on Infant, Child, and Maternal Mortality in Low- and Middle-Income Countries

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