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Effect of paying for performance on utilisation, quality, and user costs of health services in Tanzania: a controlled before and after study

Version
01
Resource Type
Dataset
Creator
  • Binyaruka, Peter (Ifakara Health Institute)
  • Patouillard, Edith (London School of Hygiene& Tropical Medicine)
  • Powell-jackson, Timothy (London School of Hygiene& Tropical Medicine)
  • Greco, Giulia (London School of Hygiene& Tropical Medicine)
  • Maestad, Ottar (Chr. Michelsens Institutt)
  • Borghi, Josephine (London School of Hygiene and Tropical Medicine)
Publication Date
2015-10-01
Publication Place
TANZANIA
Language
English
Free Keywords
Paying for Performance, Health Services, Impact Evaluation, Tanzania
Description
  • Abstract

    Despite widespread implementation across Africa, there is limited evidence of the effect of payment for performance (P4P) schemes in low income countries on the coverage of quality services and affordability, consistent with universal health coverage objectives. We examined the effect of a government P4P scheme on utilisation, quality, and user costs of health services in Tanzania. We evaluated the effects of a P4P scheme on utilisation of all maternal and child immunization services targeted by the scheme, and non-targeted general outpatient service use. We also evaluated effects on patient satisfaction with care and clinical content of antenatal care, and user costs. The evaluation was done in 150 facilities across all 7 intervention districts and 4 comparison districts with two rounds of data collection over 13-months in January 2012 and February 2013. We sampled 3000 households of women who had delivered in the 12 months prior to interview; 1500 patients attending health facilities for targeted and non-targeted services at each round of data collection. Difference-in-difference regression analysis was employed. We estimated a significant positive effect on two out of eight targeted indicators. There was an 8.2% (95% CI: 3.6% to 12.8%) increase in coverage of institutional deliveries among women in the intervention area, and a 10.3% (95% CI: 4.4% to 16.1%) increase in the provision of anti-malarials during pregnancy. Use of non-targeted services reduced at dispensaries by 57.5 visits per month among children under five (95% CI: -110.2 to -4.9) and by 90.8 visits per month for those aged over five (95% CI: -156.5 to -25.2). There was no evidence of an effect of P4P on patient experience of care for targeted services. There was a 0.05 (95% CI: 0.01 to 0.10) increase in the patient satisfaction score for non-targeted services. P4P was associated with a 5.0% reduction in those paying out of pocket for deliveries (95% CI: -9.3% to -0.7%) but there was no evidence of an effect on the average amount paid. This study adds to the very limited evidence on the effects of P4P at scale and highlights the potential risks of such schemes in relation to non-targeted service use. Further consideration of the design of P4P schemes is required to enhance progress towards universal health coverage, and close monitoring of effects on non-targeted services and user costs should be encouraged.

Temporal Coverage
  • 2012-2013
Geographic Coverage
  • Tanzania, United Republic of (TZ)
    Pwani region, Tanzania (7 districts)
Collection Mode
  • Face-to-face interview
Availability
Download
Direct Access
Rights
Creative Commons Attribution 4.0 International License.
Alternative Identifiers
  • 10.1371/journal.pone.0135013 (Type: DOI)
Publications
  • Binyaruka, Peter; Patouillard, Edith; Powell-jackson, Timothy; Greco, Giulia; Maestad, Ottar; Borghi, Josephine: Effect of Paying for Performance on Utilisation, Quality, and User Costs of Health Services in Tanzania: A Controlled Before and After Study.. In: PLoS One2015. ISSN 1932-6203 (Article)

Update Metadata: 2015-10-06 | Issue Number: 7 | Registration Date: 2015-10-06

Binyaruka, Peter; Patouillard, Edith; Powell-jackson, Timothy; Greco, Giulia; Maestad, Ottar et. al. (2015): Effect of paying for performance on utilisation, quality, and user costs of health services in Tanzania: a controlled before and after study. Version: 01. ihi - Ifakara Health Institute. Dataset. https://doi.org/10.17890/ihi.2013.02.99