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Performance-Based Financing, Motivation and Final Output in the Health Sector: Experimental Evidence from the Democratic Republic of Congo

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  • Elise Huillery

    (ECON - Département d'économie (Sciences Po) - Sciences Po - Sciences Po - CNRS - Centre National de la Recherche Scientifique)

  • Juliette Seban

    (CES - Centre d'économie de la Sorbonne - UP1 - Université Paris 1 Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique)

Abstract

Performance-based financing becomes a common strategy to improve health sector quality. The findings of this paper imply that performance-based financing should take motivational effects and levels of provider capacity into account. Using a field experiment in the Democratic Republic of Congo, we find that financial incentives led to more effort from health workers on rewarded activities, without deterring effort on non-rewarded activities. We also find a shift from intrinsic to extrinsic motivation. Finally, the increased effort by health workers proved unsuccessful and led to a reduction in revenue, suggesting that health workers lacked the capacity to develop appropriate strategies to perform.

Suggested Citation

  • Elise Huillery & Juliette Seban, 2014. "Performance-Based Financing, Motivation and Final Output in the Health Sector: Experimental Evidence from the Democratic Republic of Congo," Working Papers hal-01071880, HAL.
  • Handle: RePEc:hal:wpaper:hal-01071880
    Note: View the original document on HAL open archive server: https://hal-sciencespo.archives-ouvertes.fr/hal-01071880
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    1. Grant Miller & Kimberly Singer Babiarz, 2013. "Pay-for-Performance Incentives in Low- and Middle-Income Country Health Programs," NBER Working Papers 18932, National Bureau of Economic Research, Inc.
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    9. Benjamin A. Olken & Junko Onishi & Susan Wong, 2012. "Should Aid Reward Performance? Evidence from a Field Experiment on Health and Education in Indonesia," NBER Working Papers 17892, National Bureau of Economic Research, Inc.
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    Cited by:

    1. Fabre, Anaïs & Straub, Stéphane, 2019. "The Impact of Public-Private Partnerships (PPPs) in Infrastructure, Health and Education: A Review," TSE Working Papers 19-986, Toulouse School of Economics (TSE), revised Sep 2021.
    2. Pablo A. Celhay & Paul J. Gertler & Paula Giovagnoli & Christel Vermeersch, 2019. "Long-Run Effects of Temporary Incentives on Medical Care Productivity," American Economic Journal: Applied Economics, American Economic Association, vol. 11(3), pages 92-127, July.
    3. 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.
    4. Singh, Neha S. & Kovacs, Roxanne J. & Cassidy, Rachel & Kristensen, Søren R. & Borghi, Josephine & Brown, Garrett W., 2021. "A realist review to assess for whom, under what conditions and how pay for performance programmes work in low- and middle-income countries," Social Science & Medicine, Elsevier, vol. 270(C).
    5. Lohmann, Julia & Muula, Adamson S. & Houlfort, Nathalie & De Allegri, Manuela, 2018. "How does performance-based financing affect health workers' intrinsic motivation? A Self-Determination Theory-based mixed-methods study in Malawi," Social Science & Medicine, Elsevier, vol. 208(C), pages 1-8.
    6. Mayumana, Iddy & Borghi, Jo & Anselmi, Laura & Mamdani, Masuma & Lange, Siri, 2017. "Effects of Payment for Performance on accountability mechanisms: Evidence from Pwani, Tanzania," Social Science & Medicine, Elsevier, vol. 179(C), pages 61-73.
    7. Pablo Celhay & Paul Gertler & Paula Giavagnoli & Christel Vermeersch, 2016. "Nudging Medical Providers to Adopt and Sustain Better Quality Care Practices," Natural Field Experiments 00537, The Field Experiments Website.
    8. Sergey Shishkin & Aleksandr Temnitsky, 2017. "From Salary to the Performance-Based Remuneration of Russian Physicians: How Motivation at Work is Changing," HSE Working papers WP BRP 08/PSP/2017, National Research University Higher School of Economics.

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