Several governments in low- and middle-income countries have adopted performance-based financing to increase health care use and improve the quality of health services. We evaluated the effects of performance-based financing in the central African nation of Burundi by exploiting the staggered rollout of this financing across provinces during 2006–10.We found that performance-based financing increased the share of women delivering their babies in an institution by 22 percentage points, which reflects a relative increase of 36 percent, and the share of women using modern family planning services by 5 percentage points, a relative change of 55 percent. The overall quality score for health care facilities increased by 45 percent during the study period, but performance-based financing was found to have no effect on the quality of care as reported by patients. We did not find strong evidence of differential effects of performance-based financing across socioeconomic groups. The performance-based financing effects on the probability of using care when ill were found to be even smaller for the poor. Our findings suggest that a supply-side intervention such as performancebased financing without accompanying access incentives for poor people is unlikely to improve equity. More research into the cost-effectiveness of performance-based financing and how best to target vulnerable populations is warranted.

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Resource Information

Document Type: (PDF) Download
Author/s: Igna Bonfrer, Robert Soeters, Ellen Van de Poel, Olivier Basenya, Gashubije Longin, Frank van de Looij, and Eddy van Doorslaer
Publication ID: HEALTH AFFAIRS 33, NO. 12 (2014): 2179–2187
Countries: Burundi
Date of Publication: December 2014

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