Poster (Scientific congresses and symposiums)
Performance-based financing is not backed by credible theoretical justifications
Paul, Elisabeth; Bodson, Oriane; Ridde, Valéry
201911th European Congress on Tropical Medicine and International Health
 

Files


Full Text
Poster-Liverpool2019-PBFScopingReview-Vfinale.pdf
Author postprint (88.41 kB)
Download

All documents in ORBi are protected by a user license.

Send to



Details



Keywords :
Performance-based financing; Low- and middle-income countries; Scoping review; Theory; Principal-agent theory
Abstract :
[en] Introduction: Pay-for-performance is expanding in many health systems, both in high-income countries and in low- and middle-income countries (LMICs) where it is commonly known as “performance-based financing” (PBF). PBF results are mixed and it has been criticised for its potential perverse effects. Yet, PBF promoters fail to provide a clear and consistent explanation of why and how it is supposed to produce results and to perform better than alternative approaches. The literature on PBF-related approaches is fragmented across disciplines and much of the current cross-disciplinary research on PBF and similar schemes lacks a sound theoretical basis.1 Aim: This study explores the theoretical justifications advanced to legitimate the choice of PBF. Methods: We performed a systematic review of the scientific papers and grey literature on PBF so as to identify the theories utilised to justify it, and critically analyse them. Results: The theoretical approach that has most often been advanced to justify PBF is the principal-agent theory – arguing that its objective is to better align healthcare providers’ incentives with populations’ interests. Surprisingly, while many PBF promoters refer to this theory, a correct utilisation of it leads to the conclusion that considering the specificities of the health sector in LMICs, high-powered incentives (as are inherent to PBF) are not recommended. There is now growing consensus on the fact that the principal-agent theory is not appropriate to justify PBF – notably because it rests on wrong assumptions and does not take context into consideration. Other related (New Institutional) Economics currents have also been used to justified PBF, including property right theory, transaction cost economics, political economy theories, or behavioural economics. Non-economic approaches, relating to organisations sciences and management, have also been used to justify PBF (management control theory, operations and supply management). Conclusion: PBF is actually not justified by any credible “grand theory”, and not yet by convincing theories of change. If PBF cannot be justified neither theoretically, nor empirically, one can only conclude it is promoted on an ideological ground. Reference(s): 1. Selviaridis K., Wynstra F. Performance-based contracting: a literature review and future research directions. International Journal of Production Research 2015; 53:12, 3505-3540.
Research center :
IRSS - Institut de recherches en Sciences Sociales - ULiège
Disciplines :
Public health, health care sciences & services
Author, co-author :
Paul, Elisabeth  ;  Université de Liège - ULiège > Département des sciences sociales > Economie politique et économie de la santé
Bodson, Oriane ;  Université de Liège - ULiège > Département des sciences sociales > Economie politique et économie de la santé
Ridde, Valéry;  Institut de recherche pour le développement (IRD)
Language :
English
Title :
Performance-based financing is not backed by credible theoretical justifications
Publication date :
18 September 2019
Event name :
11th European Congress on Tropical Medicine and International Health
Event organizer :
FESTMIH
Event place :
Liverpool, United Kingdom
Event date :
16-20 September 2019
Audience :
International
Name of the research project :
ARC Effi-Santé; ARC grant for Concerted Research Actions
Funders :
FWB - Fédération Wallonie-Bruxelles [BE]
Available on ORBi :
since 19 October 2019

Statistics


Number of views
76 (2 by ULiège)
Number of downloads
13 (1 by ULiège)

Bibliography


Similar publications



Contact ORBi