In the USA there is a substantial literature on the impact of provider payment reform, however the mechanisms through which this impact is achieved is only poorly understood and hence it is difficult to draw lessons from this experience for low and middle income countries. The presentation will report findings from research conducted in Argentina, Nicaragua and Thailand on the impact of provider payment reform. A similar study design was implemented in all three countries. Researchers examined how the implementation of new forms of payment (notably capitation payment) affected:-  provider outputs (eg. utilization rates, case mix etc)  the internal organization of providers (eg. physicians’ incomes, working schedules, incentives)  market structure in the health care sector (eg. the establishment of provider networks, changes in market concentration) Significant differences in the impact of provider payment reform emerge from the three country case studies. Analysis shows how both contextual factors as well as the specific design elements of the reform affect the end outcomes. A number of lessons are derived regarding what policy makers need to take into account when designing provider payment reform so as to ensure that the incentives they set do not lead to adverse forms of behavior amongst providers.
Learning Objectives: 1. Identify the impact of new forms of provider payment, particularly capitation, on health care delivery and health care markets in low and middle income countries 2. Discuss lessons for the design and reform of provider payment in developing countries, so as to ensure that provider payment reform meets identified objectives of improving quality of care, particularly for poorer and underserved populations
Keywords: Providers,
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.