To improve access to primary health service, the Government of the Philippines has experimented with innovative techniques, including pay-for-performance incentives paid to rural health clinics and municipal health centers. Based on new evidence, the government is now interested in changing the scheme to pay the incentives directly to physicians. In this evaluation, researchers will measure the effectiveness of direct payments to physicians in raising health outcomes. The study will also look at whether health center quality ratings, combined with communicating information about health centers to the community, improves access to health facilities.
Research area: Health Systems and Service Delivery
Evaluation Sample: 240 Local Government Units
Timeline: 2013 - 2019
Intervention: Incentives, quality, information
Researchers: Junko Onishi, World Bank; Taejong Kim, Korean Development Institute; John Basa, PhilHealth
Partners: PhilHealth; Korean Development Institute; World Bank; Ajou University
Many countries are using pay-for-performance schemes---also known as performance-based payments--- to improve the quality and efficiency of healthcare services. Evidence for the effectiveness of these approaches has been mixed. More evidence is needed on the best ways to use incentives, and under what circumstances. For example, is it more effective to target health centers or physicians directly when setting up pay-for-performance programs? This evaluation will give development experts and governments more information on the uses of incentives and ways to structure them.
The Philippines has made considerable progress in health indicators over the past few decades. Infant mortality dropped by more than half between 1990 and 2006, while maternal mortality has also declined, albeit more slowly. The inadequacy of access to quality healthcare for the poor remains disconcerting, however, and progress is not fast enough to meet the 2015 Millennium Development Goals for health.
Philippines law mandates that municipal Local Government Units manage and deliver primary care services through rural health units and urban health centers. The Philippine National Health Insurance Corporation, known as PhilHealth, and the Department of Health have recently expanded the health insurance benefit coverage for the poor. As part of this, clinics receive payment incentives for enrolling families in primary care coverage. The government is looking at changing how payments are made, including whether it’s better to pay physicians directly, in addition to measuring the impact of providing information on how clinics use funds and their performance to communities and health administrators.