Reviews (n=11) | Description of included interventions | Type of studies included (no) | Targeted health care providers | Outcome reported* | Pooled data (Y/N) | Results | |
---|---|---|---|---|---|---|---|
Other outcomes | MNH specific outcomes | ||||||
Flodgren 2011[11](overview) | An incentive is any factor (financial or non-financial) that provides motivation for a particular course of action, or counts as a reason for preferring one choice compared to alternatives. Financial incentives are extrinsic sources of motivation and exist when an individual receives a monetary transfer which is made conditional on acting in a particular way | 4 reviews | physicians, dentists, nurses, and allied healthcare professions (such as physiotherapists, speech therapists etc.) involved in providing direct patient care in LMIC and HIC | Consultation or visit rates | No | Improvement in 10/17 outcomes | |
Processes of care | Improvement in 41/57 outcomes | ||||||
Referrals and admissions | Improvement in 11/16 outcomes | ||||||
Compliance | Improvement in 5/17 outcomes | ||||||
Prescribing costs | Improvement in 28/34 outcomes | ||||||
Gaarder 2010[42] | The traditional CCT programs (which is how we will refer to the nine safety-net type of programs included in the study) were specifically designed to influence demand-side factors, and, in most cases, not the supply-side factors | 41 studies related to 11 programs/interventions | General population | Clinic visits | Yes | 1.26 (1.09, 1.45) | |
Immunization-DPT | 1.08 (1.03, 1.14) | ||||||
Immunization-Full | 1.09 (0.97, 1.22) | ||||||
Nutritional improvements-stunting | 1.04 (0.92, 1.18) | ||||||
Nutritional improvements-wasting | 1.19 (0.55, 2.57) | ||||||
Giuffrida 1999[43] | Target payments remuneration. Under a target payments remuneration system a lump sum payment is made if, and only if, the PCP reaches a predetermined quantity or target level of care. | RCT: 1 ITS: 1 | Primary Care Physicians (PCPs) defined as medically qualified physicians who provide primary health care. | Immunization rates | No | Significant improvement in 1 of 2 studies | |
Gosden 2000[44] | Salary: where a lump sum payment is made to the PCP for a set number of working hours or sessions per week. Capitation: where a payment is made to a PCP for every patient for whom they provide care. Fee-for-service (FFS): where payment is made to a PCP for every item of service or unit of care that they provide. | RCTs: 2, BFA: 2 | Primary Care Physicians in HIC | Primary care physician visit | No | Narrative | |
Prescriptions | |||||||
Diagnostic and curative services | |||||||
Referrals | |||||||
Health/emergency department visits | |||||||
Hospitalization | |||||||
Compliance | |||||||
Costs | |||||||
Lagarde 2007[12] | effect of directly transferring money to households conditional on some requirements, at least 1 of which had to be related to health seeking behavior | Total: 10 RCTs:04, quasi-randomized trial: 01 controlled before-and-after study: 1 | People living in low- or middle-income countries, as defined by the World Bank. Health services and institutions in LMIC | Care seeking behavior | Immunization coverage | No | 5/5 studies showed significant improvement in at least 1of the care seeking outcome |
Anthropometric and nutritional | 3/4 studies reported significant improvement All programs showed positive outcome | ||||||
Lagarde 2009[45] | Direct monetary transfers made to households and transfers conditioned on a particular behavior or action (e.g. visit to a health facility for regular checkups). Unconditional transfers were not considered. | RCT’s : 08, controlled before after (CBA) studies: 02 | People living in low- or middle-income countries, as defined by the World Bank. Health services and institutions | Health service utilization | No | 27% increase in individuals returning for voluntary HIV counseling, 2.1 more visits per day to health facilities | |
Immunization coverage | 11-20% more children taken to the health center 23-33% more children<4 yrs. attending preventive healthcare visits 3/4 showed improvement (insignificant) | ||||||
Health outcomes | 22-25% decrease in the probability of children <3 years old being reported ill in the past month | ||||||
Child anthropometry | 3/4 studies reported improvement (1 negative) | ||||||
Oxman 2009[46] | RBF can be defined as the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target | recipients of healthcare, individual providers of healthcare, healthcare facilities, private sector organizations, public sector organizations, sub-national governments (municipalities or provinces), national governments, or multiple levels in LMIC | TB outcomes | No | Narrative | ||
Program specific outcomes | |||||||
Scott 2011[47] | Financial incentives defined in detail in terms of method of payment, level of payment. Quality of care defined broadly as of “the degree to which health care services for individuals and populations increase the likelihood of desired outcomes and are consistent with current professional knowledge | cRCT: 3CBA:2 ITS: 1 | Primary care physicians (PCPs): PCPs are defined as doctors holding A medical degree and include general practitioners, family doctors, family physicians, family practitioners, and other generalist physicians working in primary healthcare settings who fulfill primary health care tasks | Quality of care | 6/7 studies showed modest positive effects on quality of care for some primary outcome measures, but not all. One study found no effect on quality of care | ||
Town 2005[48] | The term “economic incentives” describes financial incentives where there is an increase in physician income that is a function of measurable performance criteria. These include bonus payments payable on the basis of number of specific services provided, or based on the provider achieving a target outcome or target behavior. | RCT’s: 06 | Physician in US | Preventive services | No | 1/6 studies reported significant improvement | |
Witter 2012[49] | Pay for performance refers to the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target | RCT: 1, CBA: 6, interrupted time series: 2 | providers of healthcare services (health workers and facilities), sub-national organizations (health administrations, non-governmental organizations or local governments), national governments and combinations of these in LMIC | Provider performance (QoC) | No | Mixed findings from 5 studies Both positive and negative impacts in 2 studies | |
Utilization of service (antenatal care) | Mixed findings from 4 studies | ||||||
Utilization of service (institutional delivery) | No impact on preventive care | ||||||
Utilization of service (preventive care for children) | Immunization coverage improved in 4/4 studies | ||||||
Patient outcome | Improved wasting in 1/1 study | ||||||
Zaidi 12 (unpublished)[50] | Financing platforms that addressed maternal care either as primary objective of their study or as part of a larger service package. Types of financing strategies considered for this review included cash transfers, vouchers, contracting, community health insurance schemes, national health insurance, and user fee exemption. | 12 | General population | Maternal Voucher Schemes: | Yes | 2.97 (2.38-3.71) | |
Institutional delivery | 3.70 (2.03-6.73) | ||||||
Skilled birth attendant | 3.81 (2.92-4.95) | ||||||
Complicated delivery | 1.53 (1.14-2.05) | ||||||
ANC | 3.08 (2.23-4.25) | ||||||
PNC | 2.66 (1.59-4.44) | ||||||
Maternal CCT: | 0.88 (0.76-1.02) | ||||||
Skilled birth attendant | 0.88 (0.76-1.02) | ||||||
User fee removal: | 1.57 (1.33-1.85) | ||||||
Institutional delivery | 1.58 (1.16-2.14) | ||||||
Skilled birth attendant | 1.54 (1.26-1.88) | ||||||
National health insurance: | 1.22 (0.90-1.65) | ||||||
ANC | 1.04 (1.01-1.07) | ||||||
Institutional delivery | 1.48 (0.79-2.78) | ||||||
Community based health insurance: | 1.77 (1.29-2.44) | ||||||
Institutional delivery | 3.00 (1.60-5.61) | ||||||
ANC | 1.41 (1.22-1.63) | ||||||
PNC | 0.96 (0.46-2.00) |