Health financing interventions and hypertension control: a narrative review and hypothetical model

Financial incentives have been used extensively in low-income and middle-income countries (LMICs) to improve health and service coverage. Little is known about their effectiveness in improving hypertension outcomes. We conducted a narrative literature review to document features of select supply-side (pay-for-performance, capitation) and demand-side [conditional cash transfers (CCT), vouchers] financing interventions focused on improving hypertension outcomes in primary care settings. Our review confirmed the paucity of studies, especially from LMICs. Pay-for-performance and capitation had small effects on screening, prescription practices, and blood pressure (BP) control. CCTs had mixed effects on screening and modest effects on BP control. Information on causal pathways, unintended consequences, and the use of vouchers was sparse. We then developed a conceptual model identifying pathways through which financing interventions influence hypertension outcomes. Based on this model, simulations in the context of Bangladesh indicated that pay-for-performance demands substantial financial resources but could become more favorable with increased treatment coverage.