Can paying for results help to achieve the Millennium Development Goals? Overview of the effectiveness of results-based financing

3-siders sammendrag

Objective
Results-based financing and pay-for-performance refer to the transfer of
money or material goods conditional on taking a measurable action or achieving
a predetermined performance target. Results-based financing is widely advocated
for achieving health goals, including the Millennium Development Goals.

Methods
We undertook an overview of systematic reviews of the effectiveness of
RBF.We searched the Cochrane Library, EMBASE, and MEDLINE (up to August 2007).We also searched for related articles in PubMed, checked the reference lists of retrieved articles, and contacted key informants.We included reviews with a methods section that addressed the effects of any results-based financing in the health sector targeted at patients, providers, organizations, or governments. We summarized the characteristics and findings of each review using a structured format.

Results
We found 12 systematic reviews that met our inclusion criteria. Based on
the findings of these reviews, financial incentives targeting recipients of health care
and individual healthcare professionals are effective in the short run for simple
and distinct, well-defined behavioral goals. There is less evidence that financial
incentives can sustain long-term changes. Conditional cash transfers to poor and
disadvantaged groups in Latin America are effective at increasing the uptake of
some preventive services. There is otherwise very limited evidence of the effects of
results-based financing in low- or middle-income countries.Results-based financing
can have undesirable effects, including motivating unintended behaviors, distortions
(ignoring important tasks that are not rewarded with incentives), gaming (improving
or cheating on reporting rather than improving performance), widening the resource
gap between rich and poor, and dependency on financial incentives.

Conclusion
There is limited evidence of the effectiveness of results-based financing
and almost no evidence of the cost-effectiveness of results-based financing. Based
on the available evidence and likelymechanisms through which financial incentives
work, they are more likely to influence discrete individual behaviors in the short
run and less likely to create sustained changes.