IHeidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 365, 69120 Heidelberg, Germany.
Department of Economics and Entrepreneurship Development, Faculty of Integrated development Studies, University for Development Studies, Wa Campus, Box 520, Wa, Upper West Region, Ghana.
Health Policy Plan. 2020 Oct 1;35(8):906-917. doi: 10.1093/heapol/czaa062.
In spite of the wide attention performance-based financing (PBF) has received over the past decade, no evidence is available on its impacts on quantity and mix of service provision nor on its interaction with parallel health financing interventions. Our study aimed to examine the PBF impact on quantity and mix of service provision in Burkina Faso, while accounting for the parallel introduction of a free healthcare policy. We used Health Management Information System data from 838 primary-level health facilities across 24 districts and relied on an interrupted time-series analysis with independent controls. We placed two interruptions, one to account for PBF and one to account for the free healthcare policy. In the period before the free healthcare policy, PBF produced significant but modest increases across a wide range of maternal and child services, but a significant decrease in child immunization coverage. In the period after the introduction of the free healthcare policy, PBF did not affect service provision in intervention compared with control facilities, possibly indicating a saturation effect. Our findings indicate that PBF can produce modest increases in service provision, without altering the overall service mix. Our findings, however, also indicate that the introduction of other health financing reforms can quickly crowd out the effects produced by PBF. Further qualitative research is required to understand what factors allow healthcare providers to increase the provision of some, but not all services and how they react to the joint implementation of PBF and free health care.
尽管基于绩效的融资（PBF）在过去十年中受到了广泛关注，但尚无证据表明其对服务提供的数量和组合有影响，也没有证据表明其与平行的卫生融资干预措施有相互作用。我们的研究旨在考察布基纳法索 PBF 对服务提供的数量和组合的影响，同时考虑到平行引入的免费医疗政策。我们使用了来自 24 个区的 838 个基层卫生设施的健康管理信息系统数据，并依靠具有独立对照的中断时间序列分析。我们设置了两个中断，一个是为了 PBF，一个是为了免费医疗政策。在免费医疗政策之前的时期，PBF 在广泛的母婴服务方面产生了显著但适度的增长，但儿童免疫接种覆盖率显著下降。在免费医疗政策推出后的时期，PBF 对干预设施和对照设施的服务提供都没有影响，这可能表明已经达到了饱和效应。我们的研究结果表明，PBF 可以在不改变整体服务组合的情况下，适度增加服务提供。然而，我们的研究结果也表明，引入其他卫生融资改革可以迅速抵消 PBF 产生的影响。需要进一步进行定性研究，以了解哪些因素使医疗服务提供者能够增加某些服务的提供，而不是所有服务的提供，并了解他们如何应对 PBF 和免费医疗的联合实施。
