Multitasking and Heterogeneous Treatment Effects in Pay-for-Performance in Health Care: Evidence from Rwanda

61 Pages Posted: 3 Nov 2012 Last revised: 2 May 2017

See all articles by Tisamarie Sherry

Tisamarie Sherry

Harvard University - Harvard Medical School

Sebastian Bauhoff

Center for Global Development

Manoj Mohanan

Duke University - Sanford School of Public Policy; Duke University - Department of Economics

Date Written: March 1, 2016

Abstract

Performance-based contracting is particularly challenging in health care, where multiple agents, information asymmetries and other market failures compound the critical contracting concern of multitasking. As performance-based contracting grows in developing countries, it is critical to better understand not only intended program impacts on rewarded outcomes, but also unintended program impacts such as multitasking and heterogeneous program effects in order to guide program design and scale-up. We use two waves of data from the Rwanda Demographic and Health Surveys collected before and after the quasi-experimental roll- out of Rwanda’s national pay-for-performance (P4P) program to analyze impacts on utilization of healthcare services, health outcomes and unintended consequences of P4P. We find that P4P improved some rewarded services, as well as some services that were not directly rewarded, but had no statistically significant impact on health outcomes. We do not find evidence that clearly suggests multitasking. We find that program effects vary by baseline levels of facility quality, with most improvements seen in the medium quality tier.

Keywords: Pay for Performance, Evaluation, Multitasking, Heterogeneity, Contract

JEL Classification: H43, I18, L88

Suggested Citation

Sherry, Tisamarie and Bauhoff, Sebastian and Mohanan, Manoj, Multitasking and Heterogeneous Treatment Effects in Pay-for-Performance in Health Care: Evidence from Rwanda (March 1, 2016). Economic Research Initiatives at Duke (ERID) Working Paper No. 136. Available at SSRN: https://ssrn.com/abstract=2170393 or http://dx.doi.org/10.2139/ssrn.2170393

Tisamarie Sherry

Harvard University - Harvard Medical School ( email )

25 Shattuck St
Boston, MA 02115
United States

Sebastian Bauhoff

Center for Global Development ( email )

2055 L Street NW
Washington, DC DC 20009
United States

HOME PAGE: http://scholar.harvard.edu/bauhoff/

Manoj Mohanan (Contact Author)

Duke University - Sanford School of Public Policy ( email )

201 Science Drive
Box 90312
Durham, NC 27708-0239
United States

Duke University - Department of Economics ( email )

213 Social Sciences Building
Box 90097
Durham, NC 27708-0204
United States

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