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Do incentives matter when working for god? The impact of performance-based financing on faith-based healthcare in Uganda

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  • Duchoslav, Jan
  • Cecchi, Francesco

Abstract

Can extrinsic incentives motivate faith-based healthcare providers? This paper challenges the finding that religious providers are intrinsically motivated to serve (poor) patients, and that extrinsic incentives may crowd-out such motivation. We use a unique panel of output and expenditure data from small faith-based nonprofit healthcare facilities in Uganda to estimate the effect of introducing performance-based financing. The output of the observed facilities is less than 50% of their potential. Performance-based financing increases output and efficiency robustly by at least 27%, with no apparent reduction in the perceived quality of services. Religious nonprofit healthcare providers may well be intrinsically motivated, but respond positively to extrinsic incentives. Whether working for god or not, incentives matter.

Suggested Citation

  • Duchoslav, Jan & Cecchi, Francesco, 2019. "Do incentives matter when working for god? The impact of performance-based financing on faith-based healthcare in Uganda," World Development, Elsevier, vol. 113(C), pages 309-319.
    • Handle: RePEc:eee:wdevel:v:113:y:2019:i:c:p:309-319
    DOI: 10.1016/j.worlddev.2018.09.011
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    1. Bonfrer, Igna & Van de Poel, Ellen & Van Doorslaer, Eddy, 2014. "The effects of performance incentives on the utilization and quality of maternal and child care in Burundi," Social Science & Medicine, Elsevier, vol. 123(C), pages 96-104.
    2. David E. Sahn & David Stifel, 2003. "Exploring Alternative Measures of Welfare in the Absence of Expenditure Data," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 49(4), pages 463-489, December.
    3. David Roodman, 2009. "How to do xtabond2: An introduction to difference and system GMM in Stata," Stata Journal, StataCorp LP, vol. 9(1), pages 86-136, March.
    4. Choi, In, 2001. "Unit root tests for panel data," Journal of International Money and Finance, Elsevier, vol. 20(2), pages 249-272, April.
    5. Arellano, Manuel, 1993. "On the testing of correlated effects with panel data," Journal of Econometrics, Elsevier, vol. 59(1-2), pages 87-97, September.
    6. O'Neill, Liam & Rauner, Marion & Heidenberger, Kurt & Kraus, Markus, 2008. "A cross-national comparison and taxonomy of DEA-based hospital efficiency studies," Socio-Economic Planning Sciences, Elsevier, vol. 42(3), pages 158-189, September.
    7. Kenneth L. Leonard & Melkiory C. Masatu, 2010. "Professionalism and the know‐do gap: exploring intrinsic motivation among health workers in Tanzania," Health Economics, John Wiley & Sons, Ltd., vol. 19(12), pages 1461-1477, December.
    8. Gary J. Miller, 2008. "Solutions to Principal-Agent Problems in Firms," Springer Books, in: Claude Ménard & Mary M. Shirley (ed.), Handbook of New Institutional Economics, chapter 14, pages 349-370, Springer.
    9. Bruce Hollingsworth, 2008. "The measurement of efficiency and productivity of health care delivery," Health Economics, John Wiley & Sons, Ltd., vol. 17(10), pages 1107-1128, October.
    10. Alan Maynard, 2012. "The powers and pitfalls of payment for performance," Health Economics, John Wiley & Sons, Ltd., vol. 21(1), pages 3-12, January.
    11. Heckman, James, 2013. "Sample selection bias as a specification error," Applied Econometrics, Russian Presidential Academy of National Economy and Public Administration (RANEPA), vol. 31(3), pages 129-137.
    12. Anthony Scott & William Coote, 2010. "Do regional primary‐care organisations influence primary‐care performance? A dynamic panel estimation," Health Economics, John Wiley & Sons, Ltd., vol. 19(6), pages 716-729, June.
    13. Leonard, Kenneth L., 2008. "Is patient satisfaction sensitive to changes in the quality of care? An exploitation of the Hawthorne effect," Journal of Health Economics, Elsevier, vol. 27(2), pages 444-459, March.
    14. Ssengooba, Freddie & McPake, Barbara & Palmer, Natasha, 2012. "Why performance-based contracting failed in Uganda – An “open-box” evaluation of a complex health system intervention," Social Science & Medicine, Elsevier, vol. 75(2), pages 377-383.
    15. Joanna Wolszczak-Derlacz & Aleksandra Parteka, 2011. "Efficiency of European public higher education institutions: a two-stage multicountry approach," Scientometrics, Springer;Akadémiai Kiadó, vol. 89(3), pages 887-917, December.
    16. Martina Björkman & Jakob Svensson, 2009. "Power to the People: Evidence from a Randomized Field Experiment on Community-Based Monitoring in Uganda," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 124(2), pages 735-769.
    17. Mingshan Lu, 1999. "Separating the True Effect from Gaming in Incentive‐Based Contracts in Health Care," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 8(3), pages 383-431, September.
    18. Bruno S. Frey & Reto Jegen, 2001. "Motivation Crowding Theory," Journal of Economic Surveys, Wiley Blackwell, vol. 15(5), pages 589-611, December.
    19. Abhijit V. Banerjee & Esther Duflo & Rachel Glennerster, 2008. "Putting a Band-Aid on a Corpse: Incentives for Nurses in the Indian Public Health Care System," Journal of the European Economic Association, MIT Press, vol. 6(2-3), pages 487-500, 04-05.
    20. Ritva Reinikka & Jakob Svensson, 2010. "Working for God? Evidence from a Change in Financing of Nonprofit Health Care Providers in Uganda," Journal of the European Economic Association, MIT Press, vol. 8(6), pages 1159-1178, December.
    21. Im, Kyung So & Pesaran, M. Hashem & Shin, Yongcheol, 2003. "Testing for unit roots in heterogeneous panels," Journal of Econometrics, Elsevier, vol. 115(1), pages 53-74, July.
    22. J. Michelle Brock & Andreas Lange & Kenneth L. Leonard, 2016. "Generosity and Prosocial Behavior in Healthcare Provision: Evidence from the Laboratory and Field," Journal of Human Resources, University of Wisconsin Press, vol. 51(1), pages 133-162.
    23. Lohmann, Julia & Houlfort, Nathalie & De Allegri, Manuela, 2016. "Crowding out or no crowding out? A Self-Determination Theory approach to health worker motivation in performance-based financing," Social Science & Medicine, Elsevier, vol. 169(C), pages 1-8.
    24. Simar, Leopold & Wilson, Paul W., 2007. "Estimation and inference in two-stage, semi-parametric models of production processes," Journal of Econometrics, Elsevier, vol. 136(1), pages 31-64, January.
    25. Andrew Ryan, 2009. "Hospital‐based pay‐for‐performance in the United States," Health Economics, John Wiley & Sons, Ltd., vol. 18(10), pages 1109-1113, October.
    26. Tom Walton & Kevin Matthees, 2017. "Improving Emerging Markets Healthcare through Private Provision," World Bank Publications - Reports 30358, The World Bank Group.
    27. Battese, G E & Coelli, T J, 1995. "A Model for Technical Inefficiency Effects in a Stochastic Frontier Production Function for Panel Data," Empirical Economics, Springer, vol. 20(2), pages 325-332.
    28. György Bèla Fritsche & Robert Soeters & Bruno Meessen, 2014. "Performance-Based Financing Toolkit [Boîte à outils : Financement basé sur la performance]," World Bank Publications - Books, The World Bank Group, number 17194.
    29. Anne-Marie Turcotte-Tremblay & Jessica Spagnolo & Manuela De Allegri & Valéry Ridde, 2016. "Does performance-based financing increase value for money in low- and middle- income countries? A systematic review," Health Economics Review, Springer, vol. 6(1), pages 1-18, December.
    30. Andaleeb, Syed Saad, 2001. "Service quality perceptions and patient satisfaction: a study of hospitals in a developing country," Social Science & Medicine, Elsevier, vol. 52(9), pages 1359-1370, May.
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