title: Introduction of performance-based financing in burundi was associated with improvements in care and quality.
abstract: Several governments in low- and middle-income countries have adopted performance-based financing to increase health care use and improve the quality of health services. We evaluated the effects of performance-based financing in the central African nation of Burundi by exploiting the staggered rollout of this financing across provinces during 2006-10. We found that performance-based financing increased the share of women delivering their babies in an institution by 22 percentage points, which reflects a relative increase of 36 percent, and the share of women using modern family planning services by 5 percentage points, a relative change of 55 percent. The overall quality score for health care facilities increased by 45 percent during the study period, but performance-based financing was found to have no effect on the quality of care as reported by patients. We did not find strong evidence of differential effects of performance-based financing across socioeconomic groups. The performance-based financing effects on the probability of using care when ill were found to be even smaller for the poor. Our findings suggest that a supply-side intervention such as performance-based financing without accompanying access incentives for poor people is unlikely to improve equity. More research into the cost-effectiveness of performance-based financing and how best to target vulnerable populations is warranted.
authors.affiliation: Igna Bonfrer (bonfrer@bmg.eur.nl) is a researcher at the Institute of Health Policy and Management, Erasmus University Rotterdam, the Netherlands.
authors.forename: Igna
authors.initials: I
authors.lastname: Bonfrer
authors.affiliation: Robert Soeters is a consultant for Cordaid and director and creator of SINA Health, in The Hague, the Netherlands.
authors.forename: Robert
authors.initials: R
authors.lastname: Soeters
authors.affiliation: Ellen Van de Poel is an assistant professor at the Institute of Health Policy and Management, Erasmus University Rotterdam.
authors.forename: Ellen
authors.initials: E
authors.lastname: Van de Poel
authors.affiliation: Olivier Basenya is a physician at the Ministry of Public Health, in Bujumbura, Burundi.
authors.forename: Olivier
authors.initials: O
authors.lastname: Basenya
authors.affiliation: Gashubije Longin is a physician at the Ministry of Public Health, in Bujumbura.
authors.forename: Gashubije
authors.initials: G
authors.lastname: Longin
authors.affiliation: Frank van de Looij is the international project manager for Cordaid, in The Hague.
authors.forename: Frank
authors.initials: F
authors.lastname: van de Looij
authors.affiliation: Eddy van Doorslaer is a professor at the Institute of Health Policy and Management and at the Erasmus School of Economics, Erasmus University Rotterdam.
authors.forename: Eddy
authors.initials: E
authors.lastname: van Doorslaer
mesh_terms: D000293:Adolescent; D000328:Adult; D002063:Burundi; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D061889:Healthcare Financing; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D058996:Quality Improvement / Q000458:organization & administration* / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D012052:Reimbursement, Incentive / Q000458:organization & administration; D055815:Young Adult
keywords: Financing Health Care; Health Economics