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Using performance incentives to improve health outcomes


  • Gertler, Paul
  • Vermeersch, Christel


This study examines the effect of performance incentives for health care providers to provide more and higher quality care in Rwanda on child health outcomes. The authors find that the incentives had a large and significant effect on the weight-for-age of children 0-11 months and on the height-for-age of children 24-49 months. They attribute this improvement to increases in the use and quality of prenatal and postnatal care. Consistent with theory, They find larger effects of incentives on services where monetary rewards and the marginal return to effort are higher. The also find that incentives reduced the gap between provider knowledge and practice of appropriate clinical procedures by 20 percent, implying a large gain in efficiency. Finally, they find evidence of a strong complementarity between performance incentives and provider skill.

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  • Gertler, Paul & Vermeersch, Christel, 2012. "Using performance incentives to improve health outcomes," Policy Research Working Paper Series 6100, The World Bank.
  • Handle: RePEc:wbk:wbrwps:6100

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    References listed on IDEAS

    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.
    2. Reinikka, Ritva & Svensson, Jakob, 2004. "Working for God?," CEPR Discussion Papers 4214, C.E.P.R. Discussion Papers.
    3. 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.
    4. 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.
    5. 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.
    6. Das, Jishnu & Hammer, Jeffrey, 2005. "Which doctor? Combining vignettes and item response to measure clinical competence," Journal of Development Economics, Elsevier, vol. 78(2), pages 348-383, December.
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    Cited by:

    1. Bonfrer, Igna & Van de Poel, Ellen & Van Doorslaer, Eddy, 2014. "The effects of performance incentives on the utilization and quality of maternal and child care in Burundi," Social Science & Medicine, Elsevier, vol. 123(C), pages 96-104.
    2. 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.
    3. Singh, Prakarsh & Mitra, Sandip, 2016. "Performance Pay and Malnutrition," IZA Discussion Papers 10084, Institute for the Study of Labor (IZA).
    4. Carmen Carpio & Natalia Santiago Bench, 2015. "The Health Workforce in Latin America and the Caribbean," World Bank Publications, The World Bank, number 22027, March.
    5. Prakarsh Singh & Sandip Mitra, 2015. "Performance Pay and Malnutrition: Evidence from an Experiment targeting Child Malnutrition in West Bengal," NCID Working Papers 05/2015, Navarra Center for International Development, University of Navarra.
    6. Renfu Luo & Grant Miller & Scott Rozelle & Sean Sylvia & Marcos Vera-Hernández, 2015. "Can Bureaucrats Really Be Paid Like CEOs? School Administrator Incentives for Anemia Reduction in Rural China," NBER Working Papers 21302, National Bureau of Economic Research, Inc.
    7. Dizon-Ross, Rebecca & Dupas, Pascaline & Robinson, Jonathan, 2015. "Governance and the Effectiveness of Public Health Subsidies," CEPR Discussion Papers 10690, C.E.P.R. Discussion Papers.

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    Health Monitoring&Evaluation; Population Policies; Health Systems Development&Reform; Disease Control&Prevention; Adolescent Health;

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