School of Nursing and Public Health, Discipline of Public Health, University of KwaZulu-Natal, Durban, South Africa.
Oromia Health Bureau, Addis Ababa, Ethiopia.
PLoS One. 2024 Jul 15;19(7):e0305698. doi: 10.1371/journal.pone.0305698. eCollection 2024.
Performance Based Financing (PBF) supports realization of universal health coverage by promoting bargaining between purchasers and health service providers through identifying priority services and monitoring indicators. In PBF, purchasers use health statistics and information to make decisions rather than merely reimbursing invoices. In this respect, PBF shares certain elements of strategic health purchasing. PBF implementation began in Ethiopia in 2015 as a pilot at one hospital and eight health centers. Prior to this the system predominantly followed input-based financing where providers were provided with a predetermined budget for inputs for service provision. The purpose of the study is to determine whether the implementation of PBF is cost-effective in improving maternal and child health in Ethiopia compared to the standard care.
The current study used cost-effectiveness analysis to assess the effects of PBF on maternal and child health. Two districts implementing PBF and two following standard care were selected for the study. Both groups of selected districts share common grounds before initiating PBF in the selected group. The provider perspective costing approach was used in the study. Data at the district level were gathered retrospectively for the period of July 2018 to June 2021. Data from health service statistics were transformed to population level coverages and the Lives Saved Tool method used to compute the number of lives saved. Additionally for purpose of comparison, lives saved were translated into discounted quality-adjusted life years.
The number of lives saved under PBF was 261, whereas number of lives saved under standard care was 194. The identified incremental cost per capita due to PBF was $1.8 while total costs of delivering service at PBF district was 8,816,370 USD per million population per year while the standard care costs 9,780,920 USD per million population per year. QALYs obtained under PBF and standard care were 6,118 and 4,526 per million population per year, respectively.
The conclusion made from this analysis is that, implementing PBF is cost-saving in Ethiopia compared to the standard care.
Due to lack of district-level survey-based data, such as prevalence and effects on maternal and child health, national-level estimates were used into the LiST tool.There may be some central-level PBF start-up costs that were not captured, which may have spillover effects on the existing health system performance that this study has not considered.There may be health statistics data accuracy differences between the PBF and non-PBF districts. The researchers considered using data from records as reported by both groups of districts.
绩效激励型融资（PBF）通过确定优先服务和监测指标，在购买方和医疗服务提供者之间进行谈判，从而支持实现全民健康覆盖。在 PBF 中，购买方使用卫生统计数据和信息做出决策，而不仅仅是报销发票。在这方面，PBF 与战略性卫生采购有一定的共同要素。2015 年，埃塞俄比亚在一家医院和 8 家卫生中心开始试点，开始实施 PBF。在此之前，该系统主要采用投入型融资，为服务提供提供预定的投入预算。本研究旨在确定与标准护理相比，PBF 在改善埃塞俄比亚母婴健康方面是否具有成本效益。
本研究采用成本效益分析来评估 PBF 对母婴健康的影响。选择了两个实施 PBF 的地区和两个实施标准护理的地区进行研究。在选定组中启动 PBF 之前，两组选定的地区都有共同的基础。研究采用提供者视角成本计算方法。数据是在 2018 年 7 月至 2021 年 6 月期间从地区层面收集的。从卫生服务统计数据中转化得到的人口水平覆盖率，并使用生存工具法计算出挽救的生命数量。此外，为了进行比较，挽救的生命数量被转换为贴现后的质量调整生命年。
PBF 下挽救的生命数量为 261 人，而标准护理下挽救的生命数量为 194 人。由于 PBF 而导致的人均额外成本为 1.8 美元，而在 PBF 地区提供服务的总成本为每年每百万人口 881.637 美元，而标准护理的成本为每年每百万人口 978.092 美元。PBF 和标准护理下获得的 QALYs 分别为每年每百万人口 6118 和 4526。
与标准护理相比，在埃塞俄比亚实施 PBF 是具有成本效益的。
由于缺乏基于地区的调查数据，例如母婴健康的流行率和影响，国家层面的估计被用于 LiST 工具。可能有一些中央层面的 PBF 启动成本没有被捕获，这可能对现有卫生系统绩效产生溢出效应，而这一点本研究尚未考虑。PBF 和非 PBF 地区可能存在卫生统计数据准确性差异。研究人员考虑使用两组地区报告的记录数据。
