The Impact of a Pay-for-Performance Scheme on Prescription Quality in Rural China : Impact Evaluation
In China, health care providers have traditionally been paid fee-for-service and overprescribing and high out-of-pocket spending are common. In this study, township health centers in two counties were assigned almost randomly to two groups: in one,...
| Main Authors: | , , , , , |
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| Format: | Policy Research Working Paper |
| Language: | English en_US |
| Published: |
World Bank, Washington, DC
2014
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| Subjects: | |
| Online Access: | http://documents.worldbank.org/curated/en/2014/05/19581000/impact-pay-for-performance-scheme-prescription-quality-rural-china-impact-evaluation-impact-pay-for-performance-scheme-prescription-quality-rural-china-impact-evaluation http://hdl.handle.net/10986/18794 |
| Summary: | In China, health care providers have
traditionally been paid fee-for-service and overprescribing
and high out-of-pocket spending are common. In this study,
township health centers in two counties were assigned almost
randomly to two groups: in one, fee-for-service was replaced
by a global capitated budget; in the other, by a mix of
global capitated budget and pay-for-performance. Performance
captured inter alia "irrational" drug prescribing;
20 percent of the global capitated budget was withheld each
quarter, points were deducted for failure to meet targets,
and some of the withheld budget was returned in line with
the points deducted. Outcomes included appropriate
prescribing and prescription cost, data on which were
obtained by digitizing prescriptions from a month just
before the reform and from the same month a year later.
Impacts were assessed via multivariate
differences-in-differences with township health center fixed
effects. To reduce bias from non-randomness in assignment,
the sample was trimmed by coarsened exact matching.
Pay-for-performance reduced inappropriate prescribing
significantly and substantially in the county where the
initial level was above the penalty threshold, but end-line
rates were still appreciable; no effects were seen in the
county where initial levels were around or below the
threshold, or on out-of-pocket spending in either county. |
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