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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.

Disease Control & Prevention --- Drug Prescribing --- Health Law --- Health Monitoring & Evaluation --- Health Systems Development & Reform --- Health, Nutrition and Population --- Law and Development --- Pay-for-Performance --- Population Policies

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This publication reviews performance pay schemes covering middle management and senior management levels in departments and agencies of central government and also looks at, on a selective basis, schemes for managers in other parts of the public sector. The objectives of the study were to investigate why performance-related pay schemes are being introduced at management levels in the public sector, to examine how these schemes operate, to assess whether the schemes are meeting their stated objectives, and tosee whether and under what conditions performance pay can operate successfully in public sector settings.

Governance --- Government executives --- Merit pay --- Salaries, etc --- Rating of --- Merit increases --- Merit pay programs --- Merit pay systems --- Merit-type salary schedules --- Pay for performance --- Salary schedules, Merit-type --- Variable pay --- Performance awards --- Wages --- Executives --- Public officers

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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.

Adolescent Health --- Child health --- Disease Control & Prevention --- Health Monitoring & Evaluation --- Health services --- Health Systems Development & Reform --- Health, Nutrition and Population --- Impact evaluation --- Pay-for-performance --- Performance incentives --- Population Policies --- Provider payment --- Results-based financing --- Social Development

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Argentina's Plan Nacer provides insurance for maternal and child health care to uninsured families. The program allocates funding to provinces based on enrollment of beneficiaries and adds performance incentives based on indicators of the use and quality of maternal and child health care services and health outcomes. The provinces use these resources to pay health facilities to provide maternal and child health care services to beneficiaries. This paper analyzes the impact of Plan Nacer on birth outcomes. The analysis uses data from the universe of birth records in seven Argentine provinces for 2004 to 2008 and exploits the geographic phasing in of Plan Nacer over time. The paper finds that the program increases the use and quality of prenatal care as measured by the number of visits and the probability of receiving a tetanus vaccine. Beneficiaries' probability of low birth-weight is estimated to be reduced by 19 percent. Beneficiaries have a 74 percent lower chance of in-hospital neonatal mortality in larger facilities and approximately half this reduction comes from preventing low birth weight and half from better postnatal care. The analysis finds that the cost of saving a disability-adjusted life year through the program was USD 814, which is highly cost-effective compared with Argentina's USD 6,075 gross domestic product per capita over this period. Although there are small negative spillover effects on prenatal care utilization of non-beneficiary populations in clinics covered by Plan Nacer, no spillover is found on their birth outcomes.

Adolescent Health --- Birth Outcomes --- Disease Control & Prevention --- Health Monitoring & Evaluation --- Health Systems Development & Reform --- Health, Nutrition and Population --- Impact Evaluation --- Maternal and Child Health --- Pay-for-Performance --- Population Policies --- Provider Performance --- Results-Based Financing

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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.

Adolescent Health --- Child health --- Disease Control & Prevention --- Health Monitoring & Evaluation --- Health services --- Health Systems Development & Reform --- Health, Nutrition and Population --- Impact evaluation --- Pay-for-performance --- Performance incentives --- Population Policies --- Provider payment --- Results-based financing --- Social Development