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Using Performance Incentives to Improve Medical Care Productivity and Health Outcomes

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  • Paul Gertler
  • Christel Vermeersch

Abstract

We nested a large-scale field experiment into the national rollout of the introduction of performance pay for medical care providers in Rwanda to study the effect of incentives for health care providers. In order to identify the effect of incentives separately from higher compensation, we held constant compensation across treatment and comparison groups - a portion of the treatment group's compensation was based on performance whereas the compensation of the comparison group was fixed. The incentives led to a 20% increase in productivity, and significant improvements in child health. We also find evidence of a strong complementarity between performance incentives and baseline provider skill.

Suggested Citation

  • Paul Gertler & Christel Vermeersch, 2013. "Using Performance Incentives to Improve Medical Care Productivity and Health Outcomes," NBER Working Papers 19046, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:19046
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    1. 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.
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    3. Ritva Reinikka & Jakob Svensson, 2010. "Working for God? Evidence from a Change in Financing of Nonprofit Health Care Providers in Uganda," Journal of the European Economic Association, MIT Press, vol. 8(6), pages 1159-1178, December.
    4. 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.
    5. 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, ZBW - Leibniz Information Centre for Economics, pages 1-10.
    6. Karthik Muralidharan & Venkatesh Sundararaman, 2011. "Teacher Performance Pay: Experimental Evidence from India," Journal of Political Economy, University of Chicago Press, vol. 119(1), pages 39-77.
    7. 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.
    8. Valérie Paris & Marion Devaux & Lihan Wei, 2010. "Health Systems Institutional Characteristics: A Survey of 29 OECD Countries," OECD Health Working Papers 50, OECD Publishing.
    9. World Bank, 2010. "Budgeting for Effectiveness in Rwanda : From Reconstruction to Reform," World Bank Publications, The World Bank, number 5953, June.
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    Cited by:

    1. Das,Jishnu & Holla,Alaka & Mohpal,Aakash & Muralidharan,Karthik, 2015. "Quality and accountability in healthcare delivery : audit evidence from primary care providers in India," Policy Research Working Paper Series 7334, The World Bank.
    2. Adnan Q. Khan & Asim I. Khwaja & Benjamin A. Olken, 2016. "Tax Farming Redux: Experimental Evidence on Performance Pay for Tax Collectors," The Quarterly Journal of Economics, Oxford University Press, vol. 131(1), pages 219-271.
    3. Elise Huillery & Juliette Seban, 2015. "Financial Incentives are Counterproductive in Non-Profit Sectors: Evidence from a Health Experiment," Working Papers hal-01164460, HAL.
    4. Elise Huillery & Juliette Seban, 2014. "Performance-Based Financing, Motivation and Final Output in the Health Sector: Experimental Evidence from the Democratic Republic of Congo," Université Paris1 Panthéon-Sorbonne (Post-Print and Working Papers) hal-01071880, HAL.
    5. Alzúa, María Laura & Katzkowicz, Noemí, 2021. "Pay for performance for prenatal care and newborn health: Evidence from a developing country," World Development, Elsevier, vol. 141(C).
    6. Manoj Mohanan & Katherine Donato & Grant Miller & Yulya Truskinovsky & Marcos Vera-Hernández, 2019. "Different Strokes for Different Folks: Experimental Evidence on the Effectiveness of Input and Output Incentive Contracts for Health Care Providers with Varying Skills," NBER Working Papers 25499, National Bureau of Economic Research, Inc.
    7. Fabre, Anaïs & Straub, Stéphane, 2019. "The Economic Impact of public private partnerships (PPPs) in Infrastructure, Health and Education: A Review," TSE Working Papers 19-986, Toulouse School of Economics (TSE).
    8. Dizon-Ross, Rebecca & Dupas, Pascaline & Robinson, Jonathan, 2017. "Governance and the effectiveness of public health subsidies: Evidence from Ghana, Kenya and Uganda," Journal of Public Economics, Elsevier, vol. 156(C), pages 150-169.
    9. Alzúa, María Laura & Katzkowicz, Noemí, 2021. "Pay for performance for prenatal care and newborn health: Evidence from a developing country," World Development, Elsevier, vol. 141(C).
    10. Tisamarie B. Sherry & Sebastian Bauhoff & Manoj Mohanan, 2017. "Multitasking and Heterogeneous Treatment Effects in Pay-for-Performance in Health Care: Evidence from Rwanda," American Journal of Health Economics, MIT Press, vol. 3(2), pages 192-226, Spring.
    11. Pascaline Dupas & Edward Miguel, 2016. "Impacts and Determinants of Health Levels in Low-Income Countries," NBER Working Papers 22235, National Bureau of Economic Research, Inc.

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    More about this item

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • J33 - Labor and Demographic Economics - - Wages, Compensation, and Labor Costs - - - Compensation Packages; Payment Methods
    • O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development

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