Provider payment methods and health worker motivation in community-based health insurance: A mixed-methods study

Robyn, Paul Jacob; Bärnighausen, Till; Souares, Aurélia; Traoré, A.; Bicaba, Brice; Sié, Ali; Sauerborn, Rainer

doi:10.1016/j.socscimed.2014.01.034

Cited by 17 publications

(19 citation statements)

References 43 publications

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“…The latter difference might also be explained by the relatively low subsidy for institutional deliveries in Burundi where it is not among the highest subsidized services, as it is in Rwanda. Further research is necessary to provide insights into the effectiveness of PBF in the context of demand side interventions like community based health insurance (Robyn et al, 2014) or user fee removal. All in all, it seems that the differences in the relative importance given to specific aspects of the PBF design also produced differences in incentivized outcomes.…”

Section: Discussionmentioning

confidence: 99%

The effects of performance incentives on the utilization and quality of maternal and child care in Burundi

Bonfrer

Poel

Doorslaer

2014

Social Science & Medicine

100

121

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Section: Discussionmentioning

confidence: 99%

The effects of performance incentives on the utilization and quality of maternal and child care in Burundi

Bonfrer

Poel

Doorslaer

2014

Social Science & Medicine

100

121

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“…One plausible explanation for this result is that CBI enrollees may have lowered their expectations regarding the quality of care they will receive over time. During the first few years of CBI operations health workers were providing poorer care to CBI enrollees to protest the new provider payment methods introduced by CBI [16,40]. As a result, CBI enrollees’ quality of care expectations might have changed, leading to the current subjective assessments of quality of care.…”

Section: Discussionmentioning

confidence: 99%

“…Prior research on the Nouna CBI scheme using mixed methods data [40], qualitative data [16], and data from discrete choice experiments [53] found wide-spread health-worker dissatisfaction with the CBI payment methods. The sources of dissatisfaction included (i) the low overall level of capitation; (ii) the payment schedule (once per year in July); (iii) the removal of patient user fees , and (iv) the fact that capitation was the only payment mechanism used by the CBI (when additional payment mechanisms could possibly improve health-worker motivation and the financial situation of facilities).…”

Section: Discussionmentioning

confidence: 99%

“…Our findings in Burkina Faso suggest that insurance enrollment can in fact lead to poorer objective quality of care. A principal factor for this outcome may be cost-cutting incentives for health workers generated by the type and level of provider payment method used by the scheme [40,53]. …”

Section: Discussionmentioning

confidence: 99%

“…It is plausible that poor health worker satisfaction with CBI provider payment has translated into a quality of care differential between CBI enrollees and non-enrollees [40]. …”

Section: Introductionmentioning

confidence: 99%

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Does enrollment status in community-based insurance lead to poorer quality of care? Evidence from Burkina Faso

Robyn

Bärnighausen

Souares

et al. 2013

International Journal for Equity in Health

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IntroductionIn 2004, a community-based health insurance (CBI) scheme was introduced in Nouna health district, Burkina Faso, with the objective of improving financial access to high quality health services. We investigate the role of CBI enrollment in the quality of care provided at primary-care facilities in Nouna district, and measure differences in objective and perceived quality of care and patient satisfaction between enrolled and non-enrolled populations who visit the facilities.MethodsWe interviewed a systematic random sample of 398 patients after their visit to one of the thirteen primary-care facilities contracted with the scheme; 34% (n = 135) of the patients were currently enrolled in the CBI scheme. We assessed objective quality of care as consultation, diagnostic and counselling tasks performed by providers during outpatient visits, perceived quality of care as patient evaluations of the structures and processes of service delivery, and overall patient satisfaction. Two-sample t-tests were performed for group comparison and ordinal logistic regression (OLR) analysis was used to estimate the association between CBI enrollment and overall patient satisfaction.ResultsObjective quality of care evaluations show that CBI enrollees received substantially less comprehensive care for outpatient services than non-enrollees. In contrast, CBI enrollment was positively associated with overall patient satisfaction (aOR = 1.51, p = 0.014), controlling for potential confounders such as patient socio-economic status, illness symptoms, history of illness and characteristics of care received.ConclusionsCBI patients perceived better quality of care, while objectively receiving worse quality of care, compared to patients who were not enrolled in CBI. Systematic differences in quality of care expectations between CBI enrollees and non-enrollees may explain this finding. One factor influencing quality of care may be the type of provider payment used by the CBI scheme, which has been identified as a leading factor in reducing provider motivation to deliver high quality care to CBI enrollees in previous studies. Based on this study, it is unlikely that perceived quality of care and patient satisfaction explain the low CBI enrollment rates in this community.

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Changes in inpatients' distribution and benefits under institution level–based quota payment for specific diseases in rural China: An interrupted time‐series analysis

Chen

Gao³

et al. 2018

Health Planning & Management

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SummaryThe distribution of patients is increasingly disordered in China, which leads to the waste of medical resources, increase in inpatients' economic burden, and decrease in benefits from health insurance. Institution level–based quota payment for specific diseases represents a typical payment‐system reform mode in rural China that rationalizes the distribution of rural inpatients. The aim of this study is to evaluate the effectiveness of this mode by estimating rural inpatients' distribution among hospitals at different levels, per capita cost of hospitalization, and actual compensation ratio and then to provide suggestions to advance this mode. Interrupted time‐series analysis was applied to evaluate the effect of the reform mode in the study, and Weiyuan County, Gansu Province, was selected as our sample. Institution level–based quota payment for specific diseases in Weiyuan County has rationalized the distribution of rural inpatients and improved their benefit levels. Further research should be conducted to evaluate the appropriateness of medical services, the health outcomes of rural inpatients, and the sustainability and replicability of the policy.

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Provider payment methods and health worker motivation in community-based health insurance: A mixed-methods study

Cited by 17 publications

References 43 publications

The effects of performance incentives on the utilization and quality of maternal and child care in Burundi

The effects of performance incentives on the utilization and quality of maternal and child care in Burundi

Does enrollment status in community-based insurance lead to poorer quality of care? Evidence from Burkina Faso

Changes in inpatients' distribution and benefits under institution level–based quota payment for specific diseases in rural China: An interrupted time‐series analysis

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