Table 4 Characteristics of the reviews included for Financial Platforms

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)