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Pay-for-Performance Incentives in Low- and Middle-Income Country Health Programs

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  • Grant Miller
  • Kimberly Singer Babiarz

Abstract

This chapter surveys experience with performance pay in developing country health programs. In doing so, it focuses on four key conceptual issues: (1) What to reward, (2) Who to reward, (3) How to reward, and (4) What unintended consequences might performance incentives create. We highlight that the use of performance pay has outpaced growth in corresponding empirical evidence. Moreover, very little research on performance incentives focuses on the underlying conceptual issues that we outline. We consider these to be important constraints to the design of better performance incentives in low- and middle-income country health programs.

Suggested Citation

  • 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.
  • Handle: RePEc:nbr:nberwo:18932
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    1. Gertler, Paul & Vermeersch, Christel, 2012. "Using performance incentives to improve health outcomes," Policy Research Working Paper Series 6100, The World Bank.
    2. Edward P. Lazear & Paul Oyer, 2012. "Personnel Economics [The Handbook of Organizational Economics]," Introductory Chapters,, Princeton University Press.
    3. Danila Serra & Pieter Serneels & Abigail Barr, 2010. "Intrinsic motivations and the non-profit health sector: Evidence from Ethiopia," Working Paper series, University of East Anglia, Centre for Behavioural and Experimental Social Science (CBESS) 10-01, School of Economics, University of East Anglia, Norwich, UK..
    4. Nazmul Chaudhury & Jeffrey Hammer & Michael Kremer & Karthik Muralidharan & F. Halsey Rogers, 2006. "Missing in Action: Teacher and Health Worker Absence in Developing Countries," Journal of Economic Perspectives, American Economic Association, vol. 20(1), pages 91-116, Winter.
    5. Edward P. Lazear, 2000. "The Power of Incentives," American Economic Review, American Economic Association, vol. 90(2), pages 410-414, May.
    6. Jean Tirole & Roland Bénabou, 2006. "Incentives and Prosocial Behavior," American Economic Review, American Economic Association, vol. 96(5), pages 1652-1678, December.
    7. Uri Gneezy & Stephan Meier & Pedro Rey-Biel, 2011. "When and Why Incentives (Don't) Work to Modify Behavior," Journal of Economic Perspectives, American Economic Association, vol. 25(4), pages 191-210, Fall.
    8. Edward P. Lazear, 1995. "Personnel Economics," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262121883, December.
    9. Franco, Lynne Miller & Bennett, Sara & Kanfer, Ruth, 2002. "Health sector reform and public sector health worker motivation: a conceptual framework," Social Science & Medicine, Elsevier, vol. 54(8), pages 1255-1266, April.
    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. Sima Berendes & Peter Heywood & Sandy Oliver & Paul Garner, 2011. "Quality of Private and Public Ambulatory Health Care in Low and Middle Income Countries: Systematic Review of Comparative Studies," PLOS Medicine, Public Library of Science, vol. 8(4), pages 1-10, April.
    12. Stefano DellaVigna, 2009. "Psychology and Economics: Evidence from the Field," Journal of Economic Literature, American Economic Association, vol. 47(2), pages 315-372, June.
    13. Sylvia, Sean & Luo, Renfu & Zhang, Linxiu & Shi, Yaojiang & Medina, Alexis & Rozelle, Scott, 2013. "Do you get what you pay for with school-based health programs? Evidence from a child nutrition experiment in rural China," Economics of Education Review, Elsevier, vol. 37(C), pages 1-12.
    14. Frank, Richard G. & Glazer, Jacob & McGuire, Thomas G., 2000. "Measuring adverse selection in managed health care," Journal of Health Economics, Elsevier, vol. 19(6), pages 829-854, November.
    15. Miller, Grant & Luo, Renfu & Zhang, Linxiu & Sylvia, Sean & Shi, Yaojiang & Foo, Patricia & Zhao, Qiran & Martorell, Reynaldo & Medina, Alexis & Rozelle, Scott, 2012. "Effectiveness of provider incentives for anaemia reduction in rural China: a cluster randomised trial," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 345, pages 1-10.
    16. Maureen Lewis, 2006. "Governance and Corruption in Public Health Care Systems," Working Papers 78, Center for Global Development.
    17. Brian J. Hall & Jeffrey B. Liebman, 1998. "Are CEOs Really Paid Like Bureaucrats?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 113(3), pages 653-691.
    18. McGuire, Thomas G., 2000. "Physician agency," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 9, pages 461-536, Elsevier.
    19. Hugh Gravelle & Matt Sutton & Ada Ma, 2007. "Doctor Behaviour Under a Pay for Performance Contract: Evidence from the Quality and Outcomes Framework," Working Papers 028cherp, Centre for Health Economics, University of York.
    20. 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.
    21. Tore Ellingsen & Magnus Johannesson, 2008. "Pride and Prejudice: The Human Side of Incentive Theory," American Economic Review, American Economic Association, vol. 98(3), pages 990-1008, June.
    22. Bernard Salanié, 2005. "The Economics of Contracts: A Primer, 2nd Edition," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262195259, December.
    23. Office of Health Economics, 2007. "The Economics of Health Care," For School 001490, Office of Health Economics.
    24. Fairbrother, G. & Hanson, K.L. & Friedman, S. & Butts, G.C., 1999. "The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates," American Journal of Public Health, American Public Health Association, vol. 89(2), pages 171-175.
    25. Gerard M. La Forgia & Bernard F. Couttolenc, 2008. "Hospital Performance in Brazil : The Search For Excellence," World Bank Publications - Reports 10284, The World Bank Group.
    26. Roland Bénabou & Jean Tirole, 2003. "Intrinsic and Extrinsic Motivation," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 70(3), pages 489-520.
    27. Tisamarie B. Sherry & Sebastian Bauhoff & Manoj Mohanan, 2012. "Paying for Performance When Health Care Production is Multi-Dimensional: The Impact of Rwanda's National Program on Rewarded Services, Multitasking and Health Outcome," Working Papers 12-19, Duke University, Department of Economics.
    28. Abhijit Banerjee & Angus Deaton & Esther Duflo, 2004. "Wealth, Health, and Health Services in Rural Rajasthan," American Economic Review, American Economic Association, vol. 94(2), pages 326-330, May.
    29. Kathleen J. Mullen & Richard G. Frank & Meredith B. Rosenthal, 2010. "Can you get what you pay for? Pay‐for‐performance and the quality of healthcare providers," RAND Journal of Economics, RAND Corporation, vol. 41(1), pages 64-91, March.
    30. Vermeersch, Christel & Kremer, Michael, 2005. "Schools meals, educational achievement and school competition: evidence from a randomized evaluation," Policy Research Working Paper Series 3523, The World Bank.
    31. Bandiera, Oriana & Ashraf, Nava & Jack, Kelsey, 2012. "No margin, no mission? A Field Experiment on Incentives for Pro-Social Tasks," CEPR Discussion Papers 8834, C.E.P.R. Discussion Papers.
    32. Holmstrom, Bengt & Milgrom, Paul, 1991. "Multitask Principal-Agent Analyses: Incentive Contracts, Asset Ownership, and Job Design," The Journal of Law, Economics, and Organization, Oxford University Press, vol. 7(0), pages 24-52, Special I.
    33. 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.
    34. Emir Kamenica, 2012. "Behavioral Economics and Psychology of Incentives," Annual Review of Economics, Annual Reviews, vol. 4(1), pages 427-452, July.
    35. Ellis, Randall P. & McGuire, Thomas G., 1990. "Optimal payment systems for health services," Journal of Health Economics, Elsevier, vol. 9(4), pages 375-396, December.
    36. Hillman, A.L. & Ripley, K. & Goldfarb, N. & Nuamah, I. & Weiner, J. & Lusk, E., 1998. "Physician financial incentives and feedback: Failure to increase cancer screening in Medicaid managed care," American Journal of Public Health, American Public Health Association, vol. 88(11), pages 1699-1701.
    37. Josse Delfgaauw, 2007. "Dedicated Doctors: Public and Private Provision of Health Care with Altruistic Physicians," Tinbergen Institute Discussion Papers 07-010/1, Tinbergen Institute, revised 17 Sep 2007.
    38. Singh, Prakarsh, 2011. "Performance Pay and Information: Reducing Child Malnutrition in Urban Slums," MPRA Paper 29403, University Library of Munich, Germany.
    39. Van de ven, Wynand P.M.M. & Ellis, Randall P., 2000. "Risk adjustment in competitive health plan markets," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 14, pages 755-845, Elsevier.
    40. Leonard, Kenneth L., 2003. "African traditional healers and outcome-contingent contracts in health care," Journal of Development Economics, Elsevier, vol. 71(1), pages 1-22, June.
    41. Das, Jishnu & Hammer, Jeffrey, 2004. "Strained mercy : The quality of medical care in Delhi," Policy Research Working Paper Series 3228, The World Bank.
    42. Nazmul Chaudhury & Jeffrey S. Hammer, 2004. "Ghost Doctors: Absenteeism in Rural Bangladeshi Health Facilities," The World Bank Economic Review, World Bank, vol. 18(3), pages 423-441.
    43. Jean-Jacques Laffont & Jean Tirole, 1993. "A Theory of Incentives in Procurement and Regulation," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262121743, December.
    44. Randall P. Ellis & Thomas G. McGuire, 1993. "Supply-Side and Demand-Side Cost Sharing in Health Care," Journal of Economic Perspectives, American Economic Association, vol. 7(4), pages 135-151, Fall.
    45. Michael Kremer, 2002. "Pharmaceuticals and the Developing World," Journal of Economic Perspectives, American Economic Association, vol. 16(4), pages 67-90, Fall.
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    More about this item

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development
    • O17 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Formal and Informal Sectors; Shadow Economy; Institutional Arrangements
    • Z18 - Other Special Topics - - Cultural Economics - - - Public Policy

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