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,...

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Main Authors:	Sun, Xiaojie, Liu, Xiaoyun, Sun, Qiang, Yip, Winnie, Wagstaff, Adam, Meng, Qingyue
Format:	Policy Research Working Paper
Language:	English en_US
Published:	World Bank, Washington, DC 2014
Subjects:	ANTENATAL CARE CAPITATION CENTER FOR HEALTH CHILD HEALTH CHILD HEALTH SERVICES CHRONIC ILLNESSES CITIES CLINICAL PATHWAYS CLINICS DEVELOPMENT POLICY DIAGNOSIS DOCTORS DRUG RESISTANCE EARLY YEARS ESSENTIAL DRUGS FAMILIES FEE-FOR-SERVICE HEALTH CARE HEALTH CARE FACILITIES HEALTH CARE PROVIDER HEALTH CARE PROVIDERS HEALTH CENTERS HEALTH CLINICS HEALTH COVERAGE HEALTH ECONOMICS HEALTH INSURANCE HEALTH INTERVENTIONS HEALTH MANAGEMENT HEALTH ORGANIZATION HEALTH POLICY HEALTH SERVICES HEALTH SYSTEM HEALTH SYSTEMS HEALTH-CARE PROVIDERS HEALTHCARE HEALTHCARE PROVIDERS HOSPITAL HOSPITAL MANAGEMENT HOSPITALS HUMAN DEVELOPMENT HYGIENE ILLNESS IMMUNIZATION INCOME INSURANCE INSURANCE COVERAGE INSURANCE SCHEMES INTERVENTION LOCAL GOVERNMENTS MATERNAL AND CHILD HEALTH MEDICAL COLLEGE MEDICAL STAFF MEDICINE MEDICINES MIGRANT MIGRANT WORKERS MINISTRY OF HEALTH MISUNDERSTANDING NEGATIVE EFFECTS NUMBER OF PEOPLE OUTPATIENT SERVICES PATIENT PATIENT SATISFACTION PATIENTS PHYSICAL ENVIRONMENT PHYSICIANS POLICY ANALYSIS POLICY DISCUSSIONS POLICY GOALS POLICY MAKERS POLICY RESEARCH POLICY RESEARCH WORKING PAPER POPULATION SIZE PRESCRIPTIONS PREVENTIVE CARE PRIMARY CARE PRIMARY HEALTH CARE PRIMARY HEALTH CARE FACILITIES PRIMARY HEALTH-CARE PROGRESS PROVIDER PAYMENT PROVISION OF CARE PUBLIC POLICY PUBLIC SERVICES QUALITY OF CARE RURAL HOSPITALS RURAL POPULATION RURAL RESIDENTS SERVICE PROVIDERS SOCIAL HEALTH INSURANCE SOCIAL SCIENCE TECHNICAL SKILLS TREATMENT VISITS WAR WORKERS WORLD HEALTH ORGANIZATION
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

id	okr-10986-18794
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spelling	okr-10986-187942021-04-23T14:03:49Z The Impact of a Pay-for-Performance Scheme on Prescription Quality in Rural China : Impact Evaluation Sun, Xiaojie Liu, Xiaoyun Sun, Qiang Yip, Winnie Wagstaff, Adam Meng, Qingyue ANTENATAL CARE CAPITATION CENTER FOR HEALTH CHILD HEALTH CHILD HEALTH SERVICES CHRONIC ILLNESSES CITIES CLINICAL PATHWAYS CLINICS DEVELOPMENT POLICY DIAGNOSIS DOCTORS DRUG RESISTANCE EARLY YEARS ESSENTIAL DRUGS FAMILIES FEE-FOR-SERVICE HEALTH CARE HEALTH CARE FACILITIES HEALTH CARE PROVIDER HEALTH CARE PROVIDERS HEALTH CENTERS HEALTH CLINICS HEALTH COVERAGE HEALTH ECONOMICS HEALTH INSURANCE HEALTH INTERVENTIONS HEALTH MANAGEMENT HEALTH ORGANIZATION HEALTH POLICY HEALTH SERVICES HEALTH SYSTEM HEALTH SYSTEMS HEALTH-CARE PROVIDERS HEALTHCARE HEALTHCARE PROVIDERS HOSPITAL HOSPITAL MANAGEMENT HOSPITALS HUMAN DEVELOPMENT HYGIENE ILLNESS IMMUNIZATION INCOME INSURANCE INSURANCE COVERAGE INSURANCE SCHEMES INTERVENTION LOCAL GOVERNMENTS MATERNAL AND CHILD HEALTH MEDICAL COLLEGE MEDICAL STAFF MEDICINE MEDICINES MIGRANT MIGRANT WORKERS MINISTRY OF HEALTH MISUNDERSTANDING NEGATIVE EFFECTS NUMBER OF PEOPLE OUTPATIENT SERVICES PATIENT PATIENT SATISFACTION PATIENTS PHYSICAL ENVIRONMENT PHYSICIANS POLICY ANALYSIS POLICY DISCUSSIONS POLICY GOALS POLICY MAKERS POLICY RESEARCH POLICY RESEARCH WORKING PAPER POPULATION SIZE PRESCRIPTIONS PREVENTIVE CARE PRIMARY CARE PRIMARY HEALTH CARE PRIMARY HEALTH CARE FACILITIES PRIMARY HEALTH-CARE PROGRESS PROVIDER PAYMENT PROVISION OF CARE PUBLIC POLICY PUBLIC SERVICES QUALITY OF CARE RURAL HOSPITALS RURAL POPULATION RURAL RESIDENTS SERVICE PROVIDERS SOCIAL HEALTH INSURANCE SOCIAL SCIENCE TECHNICAL SKILLS TREATMENT VISITS WAR WORKERS WORLD HEALTH ORGANIZATION 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. 2014-06-26T21:18:52Z 2014-06-26T21:18:52Z 2014-05 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 English en_US Policy Research Working Paper;No. 6892 CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo/ World Bank, Washington, DC Publications & Research :: Policy Research Working Paper Publications & Research East Asia and Pacific China
repository_type	Digital Repository
institution_category	Foreign Institution
institution	Digital Repositories
building	World Bank Open Knowledge Repository
collection	World Bank
language	English en_US
topic	ANTENATAL CARE CAPITATION CENTER FOR HEALTH CHILD HEALTH CHILD HEALTH SERVICES CHRONIC ILLNESSES CITIES CLINICAL PATHWAYS CLINICS DEVELOPMENT POLICY DIAGNOSIS DOCTORS DRUG RESISTANCE EARLY YEARS ESSENTIAL DRUGS FAMILIES FEE-FOR-SERVICE HEALTH CARE HEALTH CARE FACILITIES HEALTH CARE PROVIDER HEALTH CARE PROVIDERS HEALTH CENTERS HEALTH CLINICS HEALTH COVERAGE HEALTH ECONOMICS HEALTH INSURANCE HEALTH INTERVENTIONS HEALTH MANAGEMENT HEALTH ORGANIZATION HEALTH POLICY HEALTH SERVICES HEALTH SYSTEM HEALTH SYSTEMS HEALTH-CARE PROVIDERS HEALTHCARE HEALTHCARE PROVIDERS HOSPITAL HOSPITAL MANAGEMENT HOSPITALS HUMAN DEVELOPMENT HYGIENE ILLNESS IMMUNIZATION INCOME INSURANCE INSURANCE COVERAGE INSURANCE SCHEMES INTERVENTION LOCAL GOVERNMENTS MATERNAL AND CHILD HEALTH MEDICAL COLLEGE MEDICAL STAFF MEDICINE MEDICINES MIGRANT MIGRANT WORKERS MINISTRY OF HEALTH MISUNDERSTANDING NEGATIVE EFFECTS NUMBER OF PEOPLE OUTPATIENT SERVICES PATIENT PATIENT SATISFACTION PATIENTS PHYSICAL ENVIRONMENT PHYSICIANS POLICY ANALYSIS POLICY DISCUSSIONS POLICY GOALS POLICY MAKERS POLICY RESEARCH POLICY RESEARCH WORKING PAPER POPULATION SIZE PRESCRIPTIONS PREVENTIVE CARE PRIMARY CARE PRIMARY HEALTH CARE PRIMARY HEALTH CARE FACILITIES PRIMARY HEALTH-CARE PROGRESS PROVIDER PAYMENT PROVISION OF CARE PUBLIC POLICY PUBLIC SERVICES QUALITY OF CARE RURAL HOSPITALS RURAL POPULATION RURAL RESIDENTS SERVICE PROVIDERS SOCIAL HEALTH INSURANCE SOCIAL SCIENCE TECHNICAL SKILLS TREATMENT VISITS WAR WORKERS WORLD HEALTH ORGANIZATION
spellingShingle	ANTENATAL CARE CAPITATION CENTER FOR HEALTH CHILD HEALTH CHILD HEALTH SERVICES CHRONIC ILLNESSES CITIES CLINICAL PATHWAYS CLINICS DEVELOPMENT POLICY DIAGNOSIS DOCTORS DRUG RESISTANCE EARLY YEARS ESSENTIAL DRUGS FAMILIES FEE-FOR-SERVICE HEALTH CARE HEALTH CARE FACILITIES HEALTH CARE PROVIDER HEALTH CARE PROVIDERS HEALTH CENTERS HEALTH CLINICS HEALTH COVERAGE HEALTH ECONOMICS HEALTH INSURANCE HEALTH INTERVENTIONS HEALTH MANAGEMENT HEALTH ORGANIZATION HEALTH POLICY HEALTH SERVICES HEALTH SYSTEM HEALTH SYSTEMS HEALTH-CARE PROVIDERS HEALTHCARE HEALTHCARE PROVIDERS HOSPITAL HOSPITAL MANAGEMENT HOSPITALS HUMAN DEVELOPMENT HYGIENE ILLNESS IMMUNIZATION INCOME INSURANCE INSURANCE COVERAGE INSURANCE SCHEMES INTERVENTION LOCAL GOVERNMENTS MATERNAL AND CHILD HEALTH MEDICAL COLLEGE MEDICAL STAFF MEDICINE MEDICINES MIGRANT MIGRANT WORKERS MINISTRY OF HEALTH MISUNDERSTANDING NEGATIVE EFFECTS NUMBER OF PEOPLE OUTPATIENT SERVICES PATIENT PATIENT SATISFACTION PATIENTS PHYSICAL ENVIRONMENT PHYSICIANS POLICY ANALYSIS POLICY DISCUSSIONS POLICY GOALS POLICY MAKERS POLICY RESEARCH POLICY RESEARCH WORKING PAPER POPULATION SIZE PRESCRIPTIONS PREVENTIVE CARE PRIMARY CARE PRIMARY HEALTH CARE PRIMARY HEALTH CARE FACILITIES PRIMARY HEALTH-CARE PROGRESS PROVIDER PAYMENT PROVISION OF CARE PUBLIC POLICY PUBLIC SERVICES QUALITY OF CARE RURAL HOSPITALS RURAL POPULATION RURAL RESIDENTS SERVICE PROVIDERS SOCIAL HEALTH INSURANCE SOCIAL SCIENCE TECHNICAL SKILLS TREATMENT VISITS WAR WORKERS WORLD HEALTH ORGANIZATION Sun, Xiaojie Liu, Xiaoyun Sun, Qiang Yip, Winnie Wagstaff, Adam Meng, Qingyue The Impact of a Pay-for-Performance Scheme on Prescription Quality in Rural China : Impact Evaluation
geographic_facet	East Asia and Pacific China
relation	Policy Research Working Paper;No. 6892
description	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.
format	Publications & Research :: Policy Research Working Paper
author	Sun, Xiaojie Liu, Xiaoyun Sun, Qiang Yip, Winnie Wagstaff, Adam Meng, Qingyue
author_facet	Sun, Xiaojie Liu, Xiaoyun Sun, Qiang Yip, Winnie Wagstaff, Adam Meng, Qingyue
author_sort	Sun, Xiaojie
title	The Impact of a Pay-for-Performance Scheme on Prescription Quality in Rural China : Impact Evaluation
title_short	The Impact of a Pay-for-Performance Scheme on Prescription Quality in Rural China : Impact Evaluation
title_full	The Impact of a Pay-for-Performance Scheme on Prescription Quality in Rural China : Impact Evaluation
title_fullStr	The Impact of a Pay-for-Performance Scheme on Prescription Quality in Rural China : Impact Evaluation
title_full_unstemmed	The Impact of a Pay-for-Performance Scheme on Prescription Quality in Rural China : Impact Evaluation
title_sort	impact of a pay-for-performance scheme on prescription quality in rural china : impact evaluation
publisher	World Bank, Washington, DC
publishDate	2014
url	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
_version_	1764442704941416448

The Impact of a Pay-for-Performance Scheme on Prescription Quality in Rural China : Impact Evaluation

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