Department of Health Systems Governance and Financing, World Health Organization, 20 Avenue Appia, Geneva 1211, Switzerland.
Research Centre for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, 2-1 Naka Kunitachi, Tokyo 186-8601, Japan.
Health Policy Plan. 2023 Nov 28;38(10):1139-1153. doi: 10.1093/heapol/czad072.
Provider payment methods are traditionally examined by appraising the incentive signals inherent in individual payment mechanisms. However, mixed payment arrangements, which result in multiple funding flows from purchasers to providers, could be better understood by applying a systems approach that assesses the combined effects of multiple payment streams on healthcare providers. Guided by the framework developed by Barasa et al. (2021) (Barasa E, Mathauer I, Kabia E et al. 2021. How do healthcare providers respond to multiple funding flows? A conceptual framework and options to align them. Health Policy and Planning 36: 861-8.), this paper synthesizes the findings from six country case studies that examined multiple funding flows and describes the potential effect of multiple payment streams on healthcare provider behaviour in low- and middle-income countries. The qualitative findings from this study reveal the extent of undesirable provider behaviour occurring due to the receipt of multiple funding flows and explain how certain characteristics of funding flows can drive the occurrence of undesirable behaviours. Service and resource shifting occurred in most of the study countries; however, the occurrence of cost shifting was less evident. The perceived adequacy of payment rates was found to be the strongest driver of provider behaviour in the countries examined. The study results indicate that undesirable provider behaviours can have negative impacts on efficiency, equity and quality in healthcare service provision. Further empirical studies are required to add to the evidence on this link. In addition, future research could explore how governance arrangements can be used to coordinate multiple funding flows, mitigate unfavourable consequences and identify issues associated with the implementation of relevant governance measures.
支付方的支付方式传统上是通过评估单个支付机制中固有的激励信号来进行考察的。然而，对于由购买方向提供者提供多种资金流的混合支付安排，可以通过应用系统方法来更好地理解，该方法评估了多种支付流对医疗保健提供者的综合影响。本研究以 Barasa 等人（2021 年）制定的框架为指导（Barasa E, Mathauer I, Kabia E 等人。2021. 医疗保健提供者如何应对多种资金流？一个概念框架和使它们保持一致的选择。卫生政策和规划 36: 861-8.），综合了六项国家案例研究的结果，这些研究检查了多种资金流，并描述了多种支付流对低收入和中等收入国家医疗保健提供者行为的潜在影响。本研究的定性结果揭示了由于收到多种资金流而导致的不良提供者行为的程度，并解释了资金流的某些特征如何导致不良行为的发生。在大多数研究国家都发生了服务和资源转移；然而，成本转移的发生则不那么明显。研究发现，支付率的感知充足性是被考察国家中驱动提供者行为的最强因素。研究结果表明，不良提供者行为可能对医疗服务提供的效率、公平性和质量产生负面影响。需要进一步的实证研究来增加关于这一联系的证据。此外，未来的研究可以探讨如何利用治理安排来协调多种资金流，减轻不利后果，并确定与实施相关治理措施相关的问题。
