IDEAS home Printed from https://ideas.repec.org/a/plo/pmed00/1004033.html

Performance bonuses and the quality of primary health care delivered by family health teams in Brazil: A difference-in-differences analysis

Author

Listed:
  • Nasser Fardousi
  • Everton Nunes da Silva
  • Roxanne Kovacs
  • Josephine Borghi
  • Jorge O M Barreto
  • Søren Rud Kristensen
  • Juliana Sampaio
  • Helena Eri Shimizu
  • Luciano B Gomes
  • Letícia Xander Russo
  • Garibaldi D Gurgel
  • Timothy Powell-Jackson

Abstract

Background: Pay-for-performance (P4P) programmes to incentivise health providers to improve quality of care have been widely implemented globally. Despite intuitive appeal, evidence on the effectiveness of P4P is mixed, potentially due to differences in how schemes are designed. We exploited municipality variation in the design features of Brazil’s National Programme for Improving Primary Care Access and Quality (PMAQ) to examine whether performance bonuses given to family health team workers were associated with changes in the quality of care and whether the size of bonus mattered. Methods and findings: For this quasi-experimental study, we used a difference-in-differences approach combined with matching. We compared changes over time in the quality of care delivered by family health teams between (bonus) municipalities that chose to use some or all of the PMAQ money to provide performance-related bonuses to team workers with (nonbonus) municipalities that invested the funds using traditional input-based budgets. The primary outcome was the PMAQ score, a quality of care index on a scale of 0 to 100, based on several hundred indicators (ranging from 598 to 660) of health care delivery. We did one-to-one matching of bonus municipalities to nonbonus municipalities based on baseline demographic and economic characteristics. On the matched sample, we used ordinary least squares regression to estimate the association of any bonus and size of bonus with the prepost change over time (between November 2011 and October 2015) in the PMAQ score. We performed subgroup analyses with respect to the local area income of the family health team. The matched analytical sample comprised 2,346 municipalities (1,173 nonbonus municipalities; 1,173 bonus municipalities), containing 10,275 family health teams that participated in PMAQ from the outset. Bonus municipalities were associated with a 4.6 (95% CI: 2.7 to 6.4; p

Suggested Citation

  • Nasser Fardousi & Everton Nunes da Silva & Roxanne Kovacs & Josephine Borghi & Jorge O M Barreto & Søren Rud Kristensen & Juliana Sampaio & Helena Eri Shimizu & Luciano B Gomes & Letícia Xander Russo , 2022. "Performance bonuses and the quality of primary health care delivered by family health teams in Brazil: A difference-in-differences analysis," PLOS Medicine, Public Library of Science, vol. 19(7), pages 1-19, July.
    • Handle: RePEc:plo:pmed00:1004033
    DOI: 10.1371/journal.pmed.1004033
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004033
    Download Restriction: no
    File URL: https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1004033&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pmed.1004033?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. James J. Heckman & Hidehiko Ichimura & Petra E. Todd, 1997. "Matching As An Econometric Evaluation Estimator: Evidence from Evaluating a Job Training Programme," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 64(4), pages 605-654.
    2. Thomas Hone & Davide Rasella & Mauricio L Barreto & Azeem Majeed & Christopher Millett, 2017. "Association between expansion of primary healthcare and racial inequalities in mortality amenable to primary care in Brazil: A national longitudinal analysis," PLOS Medicine, Public Library of Science, vol. 14(5), pages 1-19, May.
    3. Ariella Kahn-Lang & Kevin Lang, 2020. "The Promise and Pitfalls of Differences-in-Differences: Reflections on 16 and Pregnant and Other Applications," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 38(3), pages 613-620, July.
    4. Ogundeji, Yewande Kofoworola & Bland, John Martin & Sheldon, Trevor Andrew, 2016. "The effectiveness of payment for performance in health care: A meta-analysis and exploration of variation in outcomes," Health Policy, Elsevier, vol. 120(10), pages 1141-1150.
    5. Ho, Daniel E. & Imai, Kosuke & King, Gary & Stuart, Elizabeth A., 2007. "Matching as Nonparametric Preprocessing for Reducing Model Dependence in Parametric Causal Inference," Political Analysis, Cambridge University Press, vol. 15(3), pages 199-236, July.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Igor F. L. Ferraz & Mariana C. Raimundo & Natalia M. A. M. Barros & Jhoyce S. Souza & Barbará M. V. Lucio & Thiago P. Tenreiro & Edna A. Reis & Danielle Maria de Souza Serio dos Santos & Luisa A. Chav, 2025. "Users’ Perspectives on Primary Care and Public Health Services in the State of Rio de Janeiro, Brazil: A Cross-Sectional Study with Implications for Healthcare Quality Assessment," IJERPH, MDPI, vol. 22(9), pages 1-18, September.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Kube, Roland & von Graevenitz, Kathrine & Löschel, Andreas & Massier, Philipp, 2019. "Do voluntary environmental programs reduce emissions? EMAS in the German manufacturing sector," Energy Economics, Elsevier, vol. 84(S1).
    2. Sakos, Grayson & Cerulli, Giovanni & Garbero, Alessandra, 2021. "Beyond the ATE: Idiosyncratic Effect Estimation to Uncover Distributional Impacts Results from 17 Impact Evaluations," 2021 Annual Meeting, August 1-3, Austin, Texas 314017, Agricultural and Applied Economics Association.
    3. Jennifer M. Alix-Garcia & Elizabeth N. Shapiro & Katharine R. E. Sims, 2012. "Forest Conservation and Slippage: Evidence from Mexico’s National Payments for Ecosystem Services Program," Land Economics, University of Wisconsin Press, vol. 88(4), pages 613-638.
    4. Solomon Asfaw & Silvio Daidone & Benjamin Davis & Josh Dewbre & Alessandro Romeo & Paul Winters & Katia Covarrubias & Habiba Djebbari, 2012. "Analytical Framework for Evaluating the Productive Impact of Cash Transfer Programmes on Household Behaviour – Methodological Guidelines for the From Protection to Production Project," Working Papers 101, International Policy Centre.
    5. Sansone, Dario, 2019. "Pink work: Same-sex marriage, employment and discrimination," Journal of Public Economics, Elsevier, vol. 180(C).
    6. Bondonio, Daniele, 2007. "The Employment Impact of Business Incentive Policies: a Comparative Evaluation of Different Forms of Assistance," POLIS Working Papers 92, Institute of Public Policy and Public Choice - POLIS.
    7. Monica Ospina, 2010. "CCT programs for consumption insurance: evidence from Colombia," Documentos de Trabajo de Valor Público 10612, Universidad EAFIT.
    8. Timothy Tyler Brown & Juan Pablo Atal, 2019. "How robust are reference pricing studies on outpatient medical procedures? Three different preprocessing techniques applied to difference‐in differences," Health Economics, John Wiley & Sons, Ltd., vol. 28(2), pages 280-298, February.
    9. Sung‐Hee Jeon, 2017. "The Long‐Term Effects of Cancer on Employment and Earnings," Health Economics, John Wiley & Sons, Ltd., vol. 26(5), pages 671-684, May.
    10. Matthew A. COLE & Robert R.J. ELLIOTT & Toshihiro OKUBO & Liyun ZHANG, 2017. "The Pollution Outsourcing Hypothesis: An empirical test for Japan," Discussion papers 17096, Research Institute of Economy, Trade and Industry (RIETI).
    11. Jung, Suhyun & Polasky, Stephen, 2018. "Partnerships to prevent deforestation in the Amazon," Journal of Environmental Economics and Management, Elsevier, vol. 92(C), pages 498-516.
    12. Calani, Mauricio & Paillacar, Manuel, 2022. "The pass-through of loan-loss-provisioning on mortgage lending: Evidence from a regulatory change," Journal of Banking & Finance, Elsevier, vol. 135(C).
    13. Siddique Abu Bakkar, 2020. "Identity-based Earning Discrimination among Chinese People," IZA Journal of Development and Migration, Sciendo & Forschungsinstitut zur Zukunft der Arbeit GmbH (IZA), vol. 11(1), pages 1-42, January.
    14. Claassen, Roger & Savage, Jeff & Loesch, Chuck & Breneman, Vince & Williams, Ryan & Mulvaney, Bill & Fairbanks, Tammy, 2017. "Additionality in Grassland Easements to Provide Migratory Bird Habitat in the Northern Plains," Journal of Agricultural and Resource Economics, Western Agricultural Economics Association, vol. 42(3), September.
    15. Dettmann, Eva & Weyh, Antje & Titze, Mirko, 2018. "Heterogeneous effects of investment grants - Evidence from a new measurement approach," IAB-Discussion Paper 201815, Institut für Arbeitsmarkt- und Berufsforschung (IAB), Nürnberg [Institute for Employment Research, Nuremberg, Germany].
    16. Ferraro, Paul J. & Miranda, Juan José, 2014. "The performance of non-experimental designs in the evaluation of environmental programs: A design-replication study using a large-scale randomized experiment as a benchmark," Journal of Economic Behavior & Organization, Elsevier, vol. 107(PA), pages 344-365.
    17. Tien Thanh, Pham & Bao Duong, Pham, 2022. "The economic burden of non-communicable diseases on households and their coping mechanisms: Evidence from rural Vietnam," World Development, Elsevier, vol. 151(C).
    18. Yu, Yunjiang & Dai, Chun & Wei, Yigang & Ren, Huiming & Zhou, Jiawen, 2022. "Air pollution prevention and control action plan substantially reduced PM2.5 concentration in China," Energy Economics, Elsevier, vol. 113(C).
    19. Roth, Jonathan & Sant’Anna, Pedro H.C. & Bilinski, Alyssa & Poe, John, 2023. "What’s trending in difference-in-differences? A synthesis of the recent econometrics literature," Journal of Econometrics, Elsevier, vol. 235(2), pages 2218-2244.
    20. Eliasson, Kent & Hansson, Pär & Lindvert, Markus, 2020. "Foreign acquisitions – A shortcut to higher productivity and expansion in smaller firms?," Working Papers 2020:4, Örebro University, School of Business.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pmed00:1004033. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosmedicine (email available below). General contact details of provider: https://journals.plos.org/plosmedicine/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.