基于绩效的融资对设施自主性和问责性的影响:来自赞比亚的证据
Chitalu Miriam Chama-Chiliba1, Peter Hangoma2, Collins Chansa3,4
1Institute of Economic and Social Research, University of Zambia, P.O. Box 30900, Lusaka, Zambia.
Health policy OPEN
|June 29, 2023
概括
在赞比亚,基于绩效的融资 (PBF) 与标准护理相比,增加了卫生工作者的自主权和问责制. 投入融资本身并没有带来类似的改善,突出了PBF的优势.
科学领域:
- 加强卫生系统 加强卫生系统
- 卫生经济学 卫生经济学
- 公共卫生政策 公共卫生政策
背景情况:
- 基于绩效的融资 (PBF) 在低收入和中等收入国家被用来增强医疗保健服务.
- 虽然PBF显示出改善服务提供和结果的潜力,但它对卫生系统机制的影响仍未得到充分研究.
研究的目的:
- 调查基于绩效的融资 (PBF) 对卫生服务提供层面的自主性和问责性的影响.
- 将PBF与赞比亚的投入融资和标准护理模式进行比较.
主要方法:
- 使用差异差异和合成控制方法.
- 分析了赞比亚三臂集群随机试验的数据.
- 比较PBF (与产出相关的融资),输入融资 (为所有输入提供融资) 和纯控制臂 (具有潜在融资挑战的标准护理).
主要成果:
- 与纯粹的控制组相比,PBF站点表现出更大的自主性和问责制.
- 与投入融资网站相比,PBF网站显示出更大的问责制.
- 与纯粹的控制部门相比,投入融资网站在自主性或问责制方面没有显著变化.
结论:
- 基于绩效的融资 (PBF) 可以增强卫生系统的财务和管理自主性和问责制.
- 管理和领导风格可能会影响PBF的有效性,因此需要进一步调查环境因素.
- 未来的研究应该探索设施经理属性和操作环境在PBF影响中的作用.
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