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In-Kind Incentives and Health Worker Performance: Experimental Evidence from El Salvador

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  • Martinez, Sebastian
  • Bernal, Pedro

Abstract

Maintaining high standards of care from doctors, nurses and other health professionals is of critical importance for an effective and efficient health system. Yet deficient levels of health worker performance, including low effort, absenteeism, and lack of compliance with clinical guidelines, have been documented across numerous countries and contexts. In response, various pay-for-performance interventions that reward providers based on measures of quality of care and health outcomes have been tested, with mixed results. This study experimentally evaluates the effects of team in-kind incentives on health worker performance in El Salvador. Thirty-eight out of 75 community health teams were randomly assigned to receive in-kind incentives linked to performance over a 12-month period. All 75 teams received monitoring, performance feedback and recognition for their achievements, allowing us to isolate the impacts of the incentive. While both treatment and control groups exhibit improvements in performance measures over time, the in-kind incentives generated significant improvements in community outreach, quality of care, timeliness of care, and utilization of services after 12 months. Contrary to conventional knowledge, gains are largest for health teams at the bottom and top of the baseline performance distribution. These results suggest that even small in-kind incentives can be a powerful tool to improve health worker performance and may be a viable alternative to monetary incentives in certain contexts.

Suggested Citation

  • Martinez, Sebastian & Bernal, Pedro, 2020. "In-Kind Incentives and Health Worker Performance: Experimental Evidence from El Salvador," IDB Publications (Working Papers) 45, Inter-American Development Bank.
  • Handle: RePEc:idb:brikps:45
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    as
    1. repec:feb:natura:0057 is not listed on IDEAS
    2. David Gill & Zdenka Kissová & Jaesun Lee & Victoria Prowse, 2019. "First-Place Loving and Last-Place Loathing: How Rank in the Distribution of Performance Affects Effort Provision," Management Science, INFORMS, vol. 65(2), pages 494-507, February.
    3. Nicola Lacetera & Mario Macis & Robert Slonim, 2012. "Will There Be Blood? Incentives and Displacement Effects in Pro-social Behavior," American Economic Journal: Economic Policy, American Economic Association, vol. 4(1), pages 186-223, February.
    4. Brian A. Jacob & Steven D. Levitt, 2003. "Rotten Apples: An Investigation of the Prevalence and Predictors of Teacher Cheating," The Quarterly Journal of Economics, Oxford University Press, vol. 118(3), pages 843-877.
    5. John List & Sally Sadoff & Mathis Wagner, 2011. "So you want to run an experiment, now what? Some simple rules of thumb for optimal experimental design," Experimental Economics, Springer;Economic Science Association, vol. 14(4), pages 439-457, November.
    6. Michael Kosfeld & Susanne Neckermann, 2011. "Getting More Work for Nothing? Symbolic Awards and Worker Performance," American Economic Journal: Microeconomics, American Economic Association, vol. 3(3), pages 86-99, August.
    7. repec:feb:artefa:0096 is not listed on IDEAS
    8. Brendon McConnell & Marcos Vera-Hernandez, 2015. "Going beyond simple sample size calculations: a practitioner's guide," IFS Working Papers W15/17, Institute for Fiscal Studies.
    9. Holmstrom, Bengt & Milgrom, Paul, 1991. "Multitask Principal-Agent Analyses: Incentive Contracts, Asset Ownership, and Job Design," Journal of Law, Economics, and Organization, Oxford University Press, vol. 7(0), pages 24-52, Special I.
    10. de Walque, Damien & Gertler, Paul J. & Bautista-Arredondo, Sergio & Kwan, Ada & Vermeersch, Christel & de Dieu Bizimana, Jean & Binagwaho, Agnès & Condo, Jeanine, 2015. "Using provider performance incentives to increase HIV testing and counseling services in Rwanda," Journal of Health Economics, Elsevier, vol. 40(C), pages 1-9.
    11. Das, Jishnu & Hammer, Jeffrey, 2007. "Money for nothing: The dire straits of medical practice in Delhi, India," Journal of Development Economics, Elsevier, vol. 83(1), pages 1-36, May.
    12. repec:pri:cheawb:kling_mto481 is not listed on IDEAS
    13. repec:feb:framed:0075 is not listed on IDEAS
    14. Brent Boning & Casey Ichniowski & Kathryn Shaw, 2007. "Opportunity Counts: Teams and the Effectiveness of Production Incentives," Journal of Labor Economics, University of Chicago Press, vol. 25, pages 613-650.
    15. Lacetera, Nicola & Macis, Mario, 2010. "Social image concerns and prosocial behavior: Field evidence from a nonlinear incentive scheme," Journal of Economic Behavior & Organization, Elsevier, vol. 76(2), pages 225-237, November.
    16. repec:pri:indrel:dsp01qz20ss50t is not listed on IDEAS
    17. Waldfogel, Joel, 1998. "The Deadweight Loss of Christmas: Reply," American Economic Review, American Economic Association, vol. 88(5), pages 1358-1359, December.
    18. Julie Berry Cullen & Randall Reback, 2006. "Tinkering Toward Accolades: School Gaming Under a Performance Accountability System," NBER Working Papers 12286, National Bureau of Economic Research, Inc.
    19. Jonathan T. Kolstad, 2013. "Information and Quality When Motivation Is Intrinsic: Evidence from Surgeon Report Cards," American Economic Review, American Economic Association, vol. 103(7), pages 2875-2910, December.
    20. David Clingingsmith & Asim Ijaz Khwaja & Michael Kremer, 2009. "Estimating the Impact of The Hajj: Religion and Tolerance in Islam's Global Gathering," The Quarterly Journal of Economics, Oxford University Press, vol. 124(3), pages 1133-1170.
    21. Jeffrey R. Kling & Jeffrey B. Liebman & Lawrence F. Katz & Lisa Sanbonmatsu, 2004. "Moving to Opportunity and Tranquility: Neighborhood Effects on Adult Economic Self-Sufficiency and Health From a Randomized Housing Voucher Experiment," Working Papers 5, Princeton University, Department of Economics, Industrial Relations Section..
    22. Jonathan T. Kolstad, 2013. "Information and Quality when Motivation is Intrinsic: Evidence from Surgeon Report Cards," NBER Working Papers 18804, National Bureau of Economic Research, Inc.
    23. Das, Jishnu & Hammer, Jeffrey, 2004. "Strained mercy : The quality of medical care in Delhi," Policy Research Working Paper Series 3228, The World Bank.
    24. Spenkuch, Jörg L., 2012. "Moral hazard and selection among the poor: Evidence from a randomized experiment," Journal of Health Economics, Elsevier, vol. 31(1), pages 72-85.
    25. Ashraf, Nava & Bandiera, Oriana & Jack, B. Kelsey, 2014. "No margin, no mission? A field experiment on incentives for public service delivery," Journal of Public Economics, Elsevier, vol. 120(C), pages 1-17.
    26. Ran Kivetz & Oleg Urminsky & Yuhuang Zheng, 2006. "The Goal-Gradient Hypothesis Resurrected: Purchase Acceleration, Illusionary Goal Progress, and Customer Retention," Natural Field Experiments 00658, The Field Experiments Website.
    27. Bernal, Pedro & Martinez, Sebastian & Celhay, Pablo, 2020. "Is Results-Based Aid More Effective than Conventional Aid?: Evidence from the Health Sector in El Salvador," IDB Publications (Working Papers) 8750, Inter-American Development Bank.
    28. repec:pri:cheawb:kling_mto481.pdf is not listed on IDEAS
    29. Jishnu Das & Jeffrey Hammer & Kenneth Leonard, 2008. "The Quality of Medical Advice in Low-Income Countries," Journal of Economic Perspectives, American Economic Association, vol. 22(2), pages 93-114, Spring.
    30. Celhay,Pablo A. & Gertler,Paul J. & Giovagnoli,Paula & Vermeersch,Christel M. J., 2015. "Long-run effects of temporary incentives on medical care productivity," Policy Research Working Paper Series 7348, The World Bank.
    31. McKenzie, David, 2012. "Beyond baseline and follow-up: The case for more T in experiments," Journal of Development Economics, Elsevier, vol. 99(2), pages 210-221.
    32. Daniel M. Koretz, 2002. "Limitations in the Use of Achievement Tests as Measures of Educators' Productivity," Journal of Human Resources, University of Wisconsin Press, vol. 37(4), pages 752-777.
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    More about this item

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • C93 - Mathematical and Quantitative Methods - - Design of Experiments - - - Field Experiments

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