LIST OF PANELS

Performance-based financing (PBF) continues to grow in popularity as a method to finance health care systems and development aid projects. Both the World Bank and World Health Organization offer guidance on designing and implementing PBF programs, and the World Bank-managed Health Results Innovation Trust Fund has committed US$385.6 million to results-based financing programs, in addition to US$2 billion in loan financing.[i] Performance-based financing is a term for supply-side results-based financing: “a form of incentive where health providers are, at least partially, funded on the basis of their performance to meet targets or undertake specific actions.”[ii]

Proponents argue that PBF can achieve fast improvements in service coverage and efficiency, and some reviews suggest that overall this is the case.[iii] However, the quality of evidence is still weak.[iv] Few studies of PBF health programs have rigorously evaluated impacts on health and equity outcomes for affected populations. Significant research gaps exist: what are the impacts of PBF on aspects of health care quality that are difficult to measure with short-term quantitative indicators? What perverse incentives can be created by PBF schemes and how can they be monitored and mitigated? How does PBF measure up compared to other health care improvement measures also associated with PBF, such as increased funding, training and/or flexibility for providers? What is the evidence for the long-term effects of PBF in health programs?[v] A wider question that may also be informed by population-level impact evaluation is how PBF programs are interacting with efforts to implement universal health coverage in developing countries.[vi]

Research Question:

· How can the effectiveness of performance-based financing models for health outcomes be evaluated?

Objectives:

· Bring together contributions from researchers who have or are carrying out evaluations of the health outcomes of PBF programs in the health sector, in developing or high-income countries, using quantitative, qualitative or mixed methods.

· Provide a forum to discuss work in progress in this area and proposals for future research directions

· Establish where data collection needs to be improved to make impact evaluation possible

· Overall, develop consensus on the quality of evaluation still needed in the area of PBF and on action needed from program implementers to facilitate rigorous evaluation

[i] RBF Health. (2014) “Mission.” https://www.rbfhealth.org/mission
[ii] World Health Organization. (2018). “Performance-based Financing.” http://www.who.int/health_financing/topics/performance-based-financing/en/
[iii] Suthar et al. “Performance-based financing for improving HIV/AIDS service delivery: a systematic review.” BMC Health Services Research (2017) 17:6; Grittner A. “Results-based financing: Evidence from performance-based financing in the health sector.” German Development Institute discussion paper, June 2013. 
[iv] Turcotte-Tremblay et al. “Does performance-based financing increase value for money in low- and middle- income countries? A systematic review.” Health Economics Review (2016) 6:30; Grittner A. “Results-based financing: Evidence from performance-based financing in the health sector.” German Development Institute discussion paper, June 2013. 
[v] Grittner A. “Results-based financing: Evidence from performance-based financing in the health sector.” German Development Institute discussion paper, June 2013. 
[vi] Soucat et al. “Pay-for-Performance Debate: Not Seeing the Forest for the Trees.” Health Systems & Reform, 3:2, 74-79.

This panel invites papers evaluating the effectiveness of performance-based financing models for improving health outcomes. Research projects can be either in-progress or complete, and papers by non-academics with experience of performance-based financing are welcome. Study methods can be quantitative, qualitative or mixed. The panel chairs will also accept discussion papers outlining how implementation methods (data collection, etc.) could better facilitate evaluation.

Performance-based financing (PBF) continues to grow in popularity as a method to finance health care systems and development aid projects. Performance-based financing is a term for supply-side results-based financing: “a form of incentive where health providers are, at least partially, funded on the basis of their performance to meet targets or undertake specific actions” (World Health Organization).

Proponents argue that PBF can achieve fast improvements in service coverage and efficiency, and some reviews suggest that overall this is the case. However, the quality of evidence is still weak.  Only a minority of studies of PBF health programs have rigorously evaluated impacts on health and equity outcomes for affected populations using a randomized controlled trial design or quasi-experimental observational methods. Significant research gaps exist: what are the impacts of PBF on aspects of health care quality that are difficult to measure with short-term quantitative indicators? What perverse incentives can be created by PBF schemes and how can they be monitored and mitigated? How does PBF measure up compared to other health care improvement measures also associated with PBF, such as increased funding, training and/or flexibility for providers? What is the evidence for the long-term effects of PBF in health programs? A wider question that may also be informed by population-level impact evaluation is how PBF programs are interacting with efforts to implement universal health coverage in developing countries.

Objectives:

· Bring together contributions from researchers who have or are carrying out rigorous impact evaluations of PBF programs in the health sector, in developing or high-income countries

· Provide a forum to discuss work in progress in this area and proposals for future research directions

· Establish where data collection needs to be improved to make impact evaluation possible

· Overall, develop consensus on the quality of evaluation still needed in the area of PBF and on action needed from program implementers to facilitate rigorous evaluation