Alignment of Performance-Based Financing in Health with the Government Budget

Piattifuenfkirchen, Moritz Otto Maria Alfons; Hadley, Sierd; Mathivet, Benoit

doi:10.1596/36362

Cited by 8 publications

(4 citation statements)

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“…This finding highlights the centrality of considering and assessing systemic constraints before implementing narrower technical solutions. For instance, a nascent body of literature points to the importance of the link between PFM and health financing reforms 43–45. To this end, health financing reform design may benefit from starting with a diagnostics exercise that (1) identifies the constraints to both the provision of and access to high quality care, (2) benchmarks the local health system (eg, whether front-line facilities have operating budgets), (3) assesses the need to leverage demand and supply side policies and (4) identifies the appropriate sequencing of health financing interventions and necessary adjustments to PFM.…”

Section: Discussionmentioning

confidence: 99%

Reviewing the evidence on health financing for effective coverage: do financial incentives work?

Walque

Kandpal

2022

BMJ Glob Health

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The widening gap between improving healthcare coverage rates and stagnating health outcomes across low-income and middle-income countries highlights the need for investments in quality of care, in addition to access. New research, presented in a World Bank report, examines one type of relevant policy reform: performance-based financing (PBF), which is a package reform that always includes performance pay to front-line health workers and often also provides facility autonomy, transparency and community engagement. A large body of rigorous studies and new analysis show that in under-resourced, centralised health systems, PBF can result in gains to service utilisation, but only has limited impacts on quality. Even the relative benefits of PBF on service utilisation are less clear when compared with (1) direct facility financing which provides front-line facilities with operating budgets and provider autonomy, but not performance pay and (2) demand-side financial support for health services (ie, conditional cash transfers and vouchers). Thus, the central component of PBF—the performance pay—appears to add little value over flexible payment systems and provider autonomy. The analysis shows that this lack of impact is unsurprising because most of the constraints to improving quality do not lie with the health worker in these settings. While PBF was conceived as a complex package ‘blueprint’, we review the evidence to conclude that only some elements seem to make sense. To improve quality of care, health financing should pivot from performance pay while retaining the elements of direct facility financing, autonomy, transparency and community engagement.

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Section: Discussionmentioning

confidence: 99%

Reviewing the evidence on health financing for effective coverage: do financial incentives work?

Walque

Kandpal

2022

BMJ Glob Health

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“…It is based on the premise of alignment of performance-based financing in health with a government budget, which has been applied in other countries. 10 In theory, the VAPM should create an alignment of incentives for population health while also providing additional funding for expansion of CHTs. Yet the VAPM has a series of statewide goals, in contrast to the community focus of the CHTs.…”

Section: Interaction Between Vapm and Chtsmentioning

confidence: 99%

“…The VAPM relies on CHTs to help achieve its health system goals, yet does not hire, employ, or control the CHTs directly. It is based on the premise of alignment of performance‐based financing in health with a government budget, which has been applied in other countries 10 . In theory, the VAPM should create an alignment of incentives for population health while also providing additional funding for expansion of CHTs.…”

Section: Introductionmentioning

confidence: 99%

Examining alignment of community health teams' preferences for health, equity, and spending with state all‐payer waiver priorities: A discrete choice experiment

van den Broek‐Altenburg,

Benson,

Atherly

2023

Health Services Research

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ObjectiveThe state of Vermont has a statewide waiver from the centers for medicare and medicaid services to allow all‐payer Accountable Care Organizations (ACOs). The Vermont all‐payer model (VAPM) waiver is layered upon previous reforms establishing regional community health teams (CHTs) and medical homes. The waiver is intended to incentivize healthcare value and quality and create alignment between health system payers, providers, and CHTs. The objective of this study was to examine CHT's trade‐offs and preferences for health, equity, and spending and the alignment with VAPM priorities.Data Sources/Study SettingData were gathered from a survey and discrete choice experiment among CHT leadership and CHT team members of the 13 CHTs in Vermont.Study DesignWe used conditional logit models to model the choice as a function of its characteristics (attributes) and mixed logit models to analyze whether preferences for programs varied by persons and roles within CHTs.Data Collection/Extraction MethodsThere were 60 respondents who completed the survey online with 14 choice tasks, with three program options in each task, for a total sample size of 2520.Principal FindingsWe found that CHTs prioritized programs in the community health plan and those with quantitative evidence of effectiveness. They were less likely to choose either programs targeting racial and ethnic minorities or programs having a small effect on a large population. Preferences did not vary across individual or community attributes. Program priorities of the VAPM, especially healthcare spending, were not prioritized.ConclusionsThe results suggest that the new VAPM does not automatically create system alignment: CHTs tended to prioritize local needs and voices. The statewide priorities are less important to CHTs, which have excellent internal alignment. This creates potential disconnection between state and community health goals. However, CHTs and the VAPM prioritize similar populations, indicating an opportunity to increase alignment by allowing flexible programs tailored to local needs. CHTs also prioritized programs with a strong evidence base, suggesting another potential avenue to create system alignment.

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“…The disparity between increasing health care coverage rates and the lack of progress in health outcomes in low-and middle-income countries underscores the need to allocate resources to improving the quality of health care in addition to ensuring accessibility. In a recent research, Piatti-Fuenfkirchen et al (2021) argued for the need for a reform of the financing of health systems known as performance-based financing (PBF). PBF refers to the allocation of financial resources to healthcare institutions, asking them to provide a pre-defined range of services in accordance with established quality and management criteria.…”

Section: Literature Reviewmentioning

confidence: 99%

Modelling Health Financing Performance in Europe in the Context of Macroeconomic Uncertainties

Dincă,

Antohi,

Andronic

et al. 2023

Economies

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This paper makes a comparison between the financing of health systems in six European Member States: France, Denmark, Spain, Bulgaria, Romania and Hungary, starting from the structure of financial allocations to health systems in the context of fluctuating macroeconomic developments marked by multiple economic crises and the onset of the pandemic, which posed a real challenge to maintaining the health security of the European population and beyond. The need for this research is connected to the gap in the literature regarding economic development, health management and health financing performance. The main objective of the research is to determine the performance aspects of health systems financing and efficient financing models in relation to the evolution of macroeconomic indicators such as gross domestic product, household final consumption, general public expenditure and population. Empirical and analytical methods consisting of literature review, database construction, econometric modeling and statistical model validation were used. The results of the study highlight the performance of financial allocations for the six countries analyzed and could help decision-makers adjust health financing strategies in line with the insights provided by the current research. The novelty of this research is the comparison between different EU member states according to their economic development level in direct connection with health financing performance. This paper identifies the key aspects of health systems’ financing and of efficient financing models in connection to the evolution of main macroeconomic indicators.

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Alignment of Performance-Based Financing in Health with the Government Budget

Cited by 8 publications

References 0 publications

Reviewing the evidence on health financing for effective coverage: do financial incentives work?

Reviewing the evidence on health financing for effective coverage: do financial incentives work?

Examining alignment of community health teams' preferences for health, equity, and spending with state all‐payer waiver priorities: A discrete choice experiment

Modelling Health Financing Performance in Europe in the Context of Macroeconomic Uncertainties

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