Roxanne Kovacs
Biographic Data
| ID | 1081016 |
|---|---|
| NAME | Roxanne Kovacs |
| GIVEN NAMES | Roxanne |
| FAMILY NAME | Kovacs |
| SIGNATURE | KOVACS R |
| AFFILIATIONS | University of Gothenburg |
| ORCID | 0000-0002-4631-3227 |
| VERIFIED | Yes |
| TOTAL WORKS | 12 |
| TOTAL CITATIONS | 5 |
| AUTHOR COUNT | 12 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 2017 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 1 |
Clinical process quality of antenatal care in low and middle-income countries: Cross-sectional evidence from 13 countries
Increasing access to high-quality antenatal care is essential for reducing maternal and neonatal mortality in low- and middle-income countries (LMICs), yet systematic evidence on the quality of care remains limited. This study provides the broadest overview to date of the clinical process quality of antenatal care in LMICs, using nationally representative data from 13 countries (Afghanistan, Democratic Republic of Congo, Egypt, Ghana, Haiti, Keny…
Does free maternity care improve uptake and save lives? Quasi-experimental evidence from Kenya
Many assume that user-fees deter healthcare-seeking in low- and middle-income countries and are therefore partially responsible for high mortality rates. This paper estimates the causal effect of a national user-fee removal programme in Kenya on healthcare seeking and mortality, using a difference-in-differences design exploiting variation in treatment intensity across local communities. Results indicate a small increase in the uptake of antenata…
Patient choice and socioeconomic disparities in the quality of healthcare: Evidence from Swedish registry data
This study explores socioeconomic disparities in how patients trade off quality against other features when choosing their primary care provider. We use a unique registry dataset linking the choices of individuals who recently moved to a new market, and therefore need to select a new provider, with detailed individual-level measures of socioeconomic status (SES) and provider-level measures of patient satisfaction, clinical quality and travel dist…
Does pay-for-performance design matter? Evidence from Brazil
Pay-for-performance (P4P) schemes have been shown to have mixed effects on health care outcomes. A challenge in interpreting this evidence is that P4P is often considered a homogenous intervention, when in practice schemes vary widely in their design. Our study contributes to this literature by providing a detailed depiction of incentive design across municipalities within a national P4P scheme in Brazil [Primary Care Access and Quality (PMAQ)] a…
The determinants of trust: Findings from large, representative samples in six OECD countries
Trust is key for economic and social development. But why do we trust others? We study the motives behind trust in strangers using an experimental trust game played by 7236 participants, in six samples representative of the general populations of Germany, Italy, Japan, Luxembourg, the UK and the USA. We examine the broadest range of potential determinants of trustor sending to date, including risk tolerance, preferences for redistribution, and co…
Who is paid in pay-for-performance? Inequalities in the distribution of financial bonuses amongst health centres in Zimbabwe
Although pay-for-performance (P4P) schemes have been implemented across low- and middle-income countries (LMICs), little is known about their distributional consequences. A key concern is that financial bonuses are primarily captured by providers who are already better able to perform (for example, those in wealthier areas), P4P could exacerbate existing inequalities within the health system. We examine inequalities in the distribution of pay-out…
Pay for performance in primary care: The contribution of the Programme for Improving Access and Quality of Primary Care (PMAQ) on avoidable hospitalisations in Brazil, 2009–2018
BACKGROUND: Evidence on the effect of pay-for-performance (P4P) schemes on provider performance is mixed in low-income and middle-income countries. Brazil introduced its first national-level P4P scheme in 2011 (PMAQ-Brazilian National Programme for Improving Primary Care Access and Quality). PMAQ is likely one of the largest P4P schemes in the world. We estimate the association between PMAQ and hospitalisations for ambulatory care sensitive condi…
A realist review to assess for whom, under what conditions and how pay for performance programmes work in low- and middle-income countries
Pay for performance (P4P) programmes are popular health system-focused interventions aiming to improve health outcomes in low-and middle-income countries (LMICs). This realist review aims to understand how, why and under what circumstance P4P works in LMICs.We systematically searched peer-reviewed and grey literature databases, and examined the mechanisms underpinning P4P effects on: utilisation of services, patient satisfaction, provider product…
Can patients improve the quality of care they receive? Experimental evidence from Senegal
Providers in many low and middle-income countries (LMICs) often fail to correctly diagnose and treat their patients, even though they have the clinical knowledge to do so. Against the backdrop of many failed attempts to increase provider effort, this study examines whether quality of care can be improved by encouraging patients to be more active during consultations. We design a simple experiment with undercover standardised patients who randomly…
Can Results-Based Financing improve health outcomes in resource poor settings? Evidence from Zimbabwe
Result Based Financing (RBF) has been implemented in health systems across low and middle-income countries (LMICs), with the objective of improving population health. Most evaluations of RBF schemes have focused on average programme effects for incentivised services. There is limited evidence on the potential effect of RBF on health outcomes, as well as on the heterogeneous effects across socio-economic groups and time periods. This study analyse…
Overconfident health workers provide lower quality healthcare
The macro-level drivers of intimate partner violence: New evidence from a multilevel dataset
This study uses multi-level regression analysis to determine the impact of macro-level drivers on intimate partner violence (IPV). It argues that we need to look beyond the usual, individual-level risk factors in order to understand why women experience abuse at the hands of their intimate partners. Using Demographic and Health Survey data from 40 developing countries, this paper demonstrates that socio-economic development, beliefs and laws play…
Can Results-Based Financing improve health outcomes in resource poor settings? Evidence from Zimbabwe
Result Based Financing (RBF) has been implemented in health systems across low and middle-income countries (LMICs), with the objective of improving population health. Most evaluations of RBF schemes have focused on average programme effects for incentivised services. There is limited evidence on the potential effect of RBF on health outcomes, as well as on the heterogeneous effects across socio-economic groups and time periods. This study analyse…
Can patients improve the quality of care they receive? Experimental evidence from Senegal
Providers in many low and middle-income countries (LMICs) often fail to correctly diagnose and treat their patients, even though they have the clinical knowledge to do so. Against the backdrop of many failed attempts to increase provider effort, this study examines whether quality of care can be improved by encouraging patients to be more active during consultations. We design a simple experiment with undercover standardised patients who randomly…
Overconfident health workers provide lower quality healthcare
The macro-level drivers of intimate partner violence: New evidence from a multilevel dataset
This study uses multi-level regression analysis to determine the impact of macro-level drivers on intimate partner violence (IPV). It argues that we need to look beyond the usual, individual-level risk factors in order to understand why women experience abuse at the hands of their intimate partners. Using Demographic and Health Survey data from 40 developing countries, this paper demonstrates that socio-economic development, beliefs and laws play…
Overconfident health workers provide lower quality healthcare
Pay for performance in primary care: The contribution of the Programme for Improving Access and Quality of Primary Care (PMAQ) on avoidable hospitalisations in Brazil, 2009–2018
BACKGROUND: Evidence on the effect of pay-for-performance (P4P) schemes on provider performance is mixed in low-income and middle-income countries. Brazil introduced its first national-level P4P scheme in 2011 (PMAQ-Brazilian National Programme for Improving Primary Care Access and Quality). PMAQ is likely one of the largest P4P schemes in the world. We estimate the association between PMAQ and hospitalisations for ambulatory care sensitive condi…
A realist review to assess for whom, under what conditions and how pay for performance programmes work in low- and middle-income countries
Pay for performance (P4P) programmes are popular health system-focused interventions aiming to improve health outcomes in low-and middle-income countries (LMICs). This realist review aims to understand how, why and under what circumstance P4P works in LMICs.We systematically searched peer-reviewed and grey literature databases, and examined the mechanisms underpinning P4P effects on: utilisation of services, patient satisfaction, provider product…
Can patients improve the quality of care they receive? Experimental evidence from Senegal
Providers in many low and middle-income countries (LMICs) often fail to correctly diagnose and treat their patients, even though they have the clinical knowledge to do so. Against the backdrop of many failed attempts to increase provider effort, this study examines whether quality of care can be improved by encouraging patients to be more active during consultations. We design a simple experiment with undercover standardised patients who randomly…
Can Results-Based Financing improve health outcomes in resource poor settings? Evidence from Zimbabwe
Result Based Financing (RBF) has been implemented in health systems across low and middle-income countries (LMICs), with the objective of improving population health. Most evaluations of RBF schemes have focused on average programme effects for incentivised services. There is limited evidence on the potential effect of RBF on health outcomes, as well as on the heterogeneous effects across socio-economic groups and time periods. This study analyse…
Who is paid in pay-for-performance? Inequalities in the distribution of financial bonuses amongst health centres in Zimbabwe
Although pay-for-performance (P4P) schemes have been implemented across low- and middle-income countries (LMICs), little is known about their distributional consequences. A key concern is that financial bonuses are primarily captured by providers who are already better able to perform (for example, those in wealthier areas), P4P could exacerbate existing inequalities within the health system. We examine inequalities in the distribution of pay-out…
Does pay-for-performance design matter? Evidence from Brazil
Pay-for-performance (P4P) schemes have been shown to have mixed effects on health care outcomes. A challenge in interpreting this evidence is that P4P is often considered a homogenous intervention, when in practice schemes vary widely in their design. Our study contributes to this literature by providing a detailed depiction of incentive design across municipalities within a national P4P scheme in Brazil [Primary Care Access and Quality (PMAQ)] a…
The determinants of trust: Findings from large, representative samples in six OECD countries
Trust is key for economic and social development. But why do we trust others? We study the motives behind trust in strangers using an experimental trust game played by 7236 participants, in six samples representative of the general populations of Germany, Italy, Japan, Luxembourg, the UK and the USA. We examine the broadest range of potential determinants of trustor sending to date, including risk tolerance, preferences for redistribution, and co…
Patient choice and socioeconomic disparities in the quality of healthcare: Evidence from Swedish registry data
This study explores socioeconomic disparities in how patients trade off quality against other features when choosing their primary care provider. We use a unique registry dataset linking the choices of individuals who recently moved to a new market, and therefore need to select a new provider, with detailed individual-level measures of socioeconomic status (SES) and provider-level measures of patient satisfaction, clinical quality and travel dist…
Clinical process quality of antenatal care in low and middle-income countries: Cross-sectional evidence from 13 countries
Increasing access to high-quality antenatal care is essential for reducing maternal and neonatal mortality in low- and middle-income countries (LMICs), yet systematic evidence on the quality of care remains limited. This study provides the broadest overview to date of the clinical process quality of antenatal care in LMICs, using nationally representative data from 13 countries (Afghanistan, Democratic Republic of Congo, Egypt, Ghana, Haiti, Keny…
Does free maternity care improve uptake and save lives? Quasi-experimental evidence from Kenya
Many assume that user-fees deter healthcare-seeking in low- and middle-income countries and are therefore partially responsible for high mortality rates. This paper estimates the causal effect of a national user-fee removal programme in Kenya on healthcare seeking and mortality, using a difference-in-differences design exploiting variation in treatment intensity across local communities. Results indicate a small increase in the uptake of antenata…
Economics (9 works) · Healthcare Policy and Management (8 works) · Medicine (8 works) · Environmental health (7 works) · Health care (7 works) · Business (5 works) · Economic growth (5 works) · Global Maternal and Child Health (5 works) · Population (5 works) · Primary Care and Health Outcomes (5 works)