The impact of performance incentives on child health outcomes
Results from a cluster randomized controlled trial in the Philippines
Bibliographic Data
| ID | 11490291 |
|---|---|
| Authors | John Peabody (0000-0002-0210-9232, University of the Philippines Diliman, corresponding author), J W Peabody, Riti Shimkhada (0000-0002-5177-4853, University of the Philippines Diliman), Stella Quimbo (University of California, San Francisco), Orville Solon (University of California, San Francisco), Xylee Javier (0009-0002-9549-8616, University of the Philippines Diliman), Charles E Mcculloch (0000-0002-1279-6179, University of the Philippines Diliman), C McCulloch |
| Year | 2014 |
| Volume | 29 |
| Issue | 5 |
| Pages | 615-621 |
| Publication date | 2014-08-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Health Policy and Planning (JOURNAL) |
| Journal identifiers | ISSN: 0268-1080 • E-ISSN: 1460-2237 |
| Publisher | Oxford University Press (PUBLISHER • GB) |
| DOI | 10.1093/heapol/czt047 |
| PMID | 24134922 |
| PMCID | PMC4124243 |
| OpenAlex | W2167571715 |
| Language | EN |
| Citations received | 18 |
| References cited | 33 |
Improving clinical performance using measurement and payment incentives, including pay for performance (or P4P), has, so far, shown modest to no benefit on patient outcomes. Our objective was to assess the impact of a P4P programme on paediatric health outcomes in the Philippines. We used data from the Quality Improvement Demonstration Study. In this study, the P4P intervention, introduced in 2004, was randomly assigned to 10 community district hospitals, which were matched to 10 control sites. At all sites, physician quality was measured using Clinical Performance Vignettes (CPVs) among randomly selected physicians every 6 months over a 36-month period. In the hospitals randomized to the P4P intervention, physicians received bonus payments if they met qualifying scores on the CPV. We measured health outcomes 4-10 weeks after hospital discharge among children 5 years of age and under who had been hospitalized for diarrhoea and pneumonia (the two most common illnesses affecting this age cohort) and had been under the care of physicians participating in the study. Health outcomes data collection was done at baseline/pre-intervention and 2 years post-intervention on the following post-discharge outcomes: (1) age-adjusted wasting, (2) C-reactive protein in blood, (3) haemoglobin level and (4) parental assessment of child's health using general self-reported health (GSRH) measure. To evaluate changes in health outcomes in the control vs intervention sites over time (baseline vs post-intervention), we used a difference-in-difference logistic regression analysis, controlling for potential confounders. We found an improvement of 7 and 9 percentage points in GSRH and wasting over time (post-intervention vs baseline) in the intervention sites relative to the control sites (P ≤ 0.001). The results from this randomized social experiment indicate that the introduction of a performance-based incentive programme, which included measurement and feedback, led to improvements in two important child health outcomes.
Business · Child health · Cluster (spacecraft) · Cluster randomised controlled trial · Developing country · Economic growth · Economics · Environmental health · Family medicine · Incentive · Microeconomics · Randomized controlled trial · Computer Science · Global Health Care Issues · Global Maternal and Child Health · Healthcare Policy and Management · Medicine · Psychology
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| Unique citing works | 18 |
|---|---|
| Citations per year | 1,5 |
| Citation span | 2014 - 2025 (12) |
| Citation velocity | recent |
| Highly cited | No |
| Citation types | Neutral: 16 |