Paying for Better Results
The panelists at this afternoon's session on performance-based incentives had no trouble talking about pay for healthcare workers and even patients, under the right circumstances. That was in marked contrast to this morning's squeamishness on the topic in the brain-drain session.
Of course, the incentives being talked about in this afternoon's discussion were all for folks in the private sector, non-government organizatons and the like--and the panelists skipped any deep forays into the strengthening of public hospitals and clinics. But I guess you can't have everything.
In any event, the session was packed--standing room only, with a few participants sitting on the floor here and there. Intriguing reports about local programs in Haiti, Nicaragua and Afghanistan.
Also, it was the first time I ever heard anyone suggest making incentive payments to poor people getting treated for tuberculosis so that they will complete the full course of therapy and not just stop after two months when they feel better and decide they need to look for a job.
Update: For more information on treatment incentives for TB patients, Ruth Levine of the Center for Global Development suggests taking a look at a report one of the CGD's working groups has written on the subject. You'll find it here.
1 comment:
The session on performance-based incentives was indeed focused quite squarely on what it takes to improve utilization, quality and efficiency in health care -- including and especially providing cash or other material rewards in particular ways to workers and patients. Part of this is motivated by a need to find creative ways to supplement salaries and facility budgets so they are at a "living wage" level, but the crucial element is the programs are trying to change behavior in very targeted ways. To achieve this, the payment is tied to performance (albeit measured in a rather narrow sense in some cases) instead of as a straight transfer. There are some important public sector applications of this (esp. Rwanda), but it's certainly true that many of the performance-based incentives so far have been introduced through NGO and/or other private providers. (For more on the TB examples, see: http://www.cgdev.org/content/publications/detail/13544.)
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