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Performance-based Incentives for Health: Demand- and Supply-Side Incentives in the Nicaraguan Red de Protección Social

Author

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  • Ferdinando Regalía
  • Leslie Castro

Abstract

While it is difficult to disentangle the individual impact of performance-based, demand-side interventions from the impact of performance-based, supply-side incentives, a rigorous evaluation of the program shows that their combination can work to increase the utilization of health services among the poor, and to improve health outcomes significantly. An evaluation undertaken ten months after demand-side incentives were stopped in certain areas revealed that the utilization of preventive health care services remained high. It is possible, therefore, that a well-targeted strategy of supply-side, performance-based incentives on its own may be sufficient to maintain high levels of health care service utilization, at least among poor households that have benefited from a relatively long period of education on the importance of preventive health care, while receiving demand-side financial incentives. However, the RPS evaluation results cannot exclude that, even after their removal, demand side incentives continue to exert, at least in the short term, a positive impact on service utilization. In the implementation of future RPS-type approaches, research efforts should focus on and be devoted to “unbundling the bundle” and assessing the relative contribution of supply vs. demand-side incentives.

Suggested Citation

  • Ferdinando Regalía & Leslie Castro, 2007. "Performance-based Incentives for Health: Demand- and Supply-Side Incentives in the Nicaraguan Red de Protección Social," Working Papers 119, Center for Global Development.
  • Handle: RePEc:cgd:wpaper:119
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    File URL: http://www.cgdev.org/files/13541_file_Nicaragua_final.pdf
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    References listed on IDEAS

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    1. John A. Maluccio, 2009. "Household targeting in practice: The Nicaraguan Red de Protección Social," Journal of International Development, John Wiley & Sons, Ltd., vol. 21(1), pages 1-23.
    2. John A. Maluccio & Alexis Murphy & Ferdinando Regalia, 2009. "Does Supply Matter? Initial Supply Conditions and the Effectiveness of Conditional Cash Transfers for Grade Progression in Nicaragua," Middlebury College Working Paper Series 0908, Middlebury College, Department of Economics.
    3. Schady, Norbert & Araujo, Maria Caridad, 2006. "Cash transfers, conditions, school enrollment, and child work : evidence from a randomized experiment in Ecuador," Policy Research Working Paper Series 3930, The World Bank.
    4. Maluccio, John A., 2005. "Coping with the “coffee crisis” in Central America: The Role of the Nicaraguan Red de Protección Social," FCND discussion papers 188, International Food Policy Research Institute (IFPRI).
    5. Natàlia Caldés & John A. Maluccio, 2005. "The cost of conditional cash transfers," Journal of International Development, John Wiley & Sons, Ltd., vol. 17(2), pages 151-168.
    6. Skoufias, Emmanuel, 2005. "PROGRESA and its impacts on the welfare of rural households in Mexico:," Research reports 139, International Food Policy Research Institute (IFPRI).
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    Cited by:

    1. Gentilini, Ugo & Omamo, Steven Were, 2011. "Social protection 2.0: Exploring issues, evidence and debates in a globalizing world," Food Policy, Elsevier, vol. 36(3), pages 329-340, June.
    2. John Maluccio & Alexis Murphy & Ferdinando Regalia, 2010. "Does supply matter? Initial schooling conditions and the effectiveness of conditional cash transfers for grade progression in Nicaragua," Journal of Development Effectiveness, Taylor & Francis Journals, vol. 2(1), pages 87-116.
    3. Tania Barham & Karen Macours & John A. Maluccio, 2013. "More Schooling and More Learning?: Effects of a Three-Year Conditional Cash Transfer Program in Nicaragua after 10 Years," IDB Publications (Working Papers) 4584, Inter-American Development Bank.
    4. Ariel Fiszbein & Norbert Schady & Francisco H.G. Ferreira & Margaret Grosh & Niall Keleher & Pedro Olinto & Emmanuel Skoufias, 2009. "Conditional Cash Transfers : Reducing Present and Future Poverty," World Bank Publications, The World Bank, number 2597.
    5. Martin Chalkley & Andrew Mirelman & Luigi Siciliani & Marc Suhrcke, 2016. "Paying for performance for health care in low- and middle-income countries: an economic perspective," Working Papers 140cherp, Centre for Health Economics, University of York.

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    Keywords

    Nicaragua; cash transfer programs; CCT; Health;

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