Effectiveness of Provider Incentives for Anaemia Reduction in Rural China: A Cluster Randomised Trial

BMJ 2012; 345:e4809 DOI: 10.1136/bmj.e4809

Posted: 3 Apr 2013 Last revised: 7 Apr 2013

See all articles by Grant Miller

Grant Miller

Stanford University - School of Medicine; National Bureau of Economic Research (NBER)

Renfu Luo

Chinese Academy of Social Sciences (CASS) - Center for Chinese Agricultural Policy (CCAP)

Linxiu Zhang

Chinese Academy of Sciences - Center for Chinese Agricultural Policy

Sean Sylvia

Renmin University of China - School of Economics

Yaojiang Shi

Shaanxi Normal University

Patricia Foo

Stanford University

Qiran Zhao

Leibniz Institute of Agricultural Development in Transition Economies (IAMO)

Reynaldo Martorell

Emory University

Alexis Medina

Stanford University

Scott Rozelle

Stanford University - Freeman Spogli Institute of International Studies

Date Written: July 27, 2012

Abstract

Objectives: To test the impact of provider performance pay for anaemia reduction in rural China.

Design: A cluster randomised trial of information, subsidies, and incentives for school principals to reduce anaemia among their students. Enumerators and study participants were not informed of study arm assignment.

Setting: 72 randomly selected rural primary schools across northwest China.

Participants: 3553 fourth and fifth grade students aged 9-11 years. All fourth and fifth grade students in sample schools participated in the study.

Interventions: Sample schools were randomly assigned to a control group, with no intervention, or one of three treatment arms: (a) an information arm, in which principals received information about anaemia; (b) a subsidy arm, in which principals received information and unconditional subsidies; and (c) an incentive arm, in which principals received information, subsidies, and financial incentives for reducing anaemia among students. Twenty seven schools were assigned to the control arm (1816 students at baseline, 1623 at end point), 15 were assigned to the information arm (659 students at baseline, 596 at end point), 15 to the subsidy arm (726 students at baseline, 667 at end point), and 15 to the incentive arm (743 students at baseline, 667 at end point).

Main Outcome Measures: Student haemoglobin concentrations.

Results: Mean student haemoglobin concentration rose by 1.5 g/L (95% CI –1.1 to 4.1) in information schools, 0.8 g/L (–1.8 to 3.3) in subsidy schools, and 2.4 g/L (0 to 4.9) in incentive schools compared with the control group. This increase in haemoglobin corresponded to a reduction in prevalence of anaemia (Hb <115 g/L) of 24% in incentive schools. Interactions with pre-existing incentives for principals to achieve good academic performance led to substantially larger gains in the information and incentive arms: when combined with incentives for good academic performance, associated effects on student haemoglobin concentration were 9.8 g/L (4.1 to 15.5) larger in information schools and 8.6 g/L (2.1 to 15.1) larger in incentive schools.

Conclusions: Financial incentives for health improvement were modestly effective. Understanding interactions with other motives and pre-existing incentives is critical.

Keywords: Education, China, United Kingdom

Suggested Citation

Miller, Grant and Luo, Renfu and Zhang, Linxiu and Sylvia, Sean and Shi, Yaojiang and Foo, Patricia and Zhao, Qiran and Martorell, Reynaldo and Medina, Alexis and Rozelle, Scott, Effectiveness of Provider Incentives for Anaemia Reduction in Rural China: A Cluster Randomised Trial (July 27, 2012). BMJ 2012; 345:e4809 DOI: 10.1136/bmj.e4809. Available at SSRN: https://ssrn.com/abstract=2243846

Grant Miller

Stanford University - School of Medicine ( email )

291 Campus Drive
Li Ka Shing Building
Stanford, CA 94305-5101
United States

National Bureau of Economic Research (NBER) ( email )

1050 Massachusetts Avenue
Cambridge, MA 02138
United States

Renfu Luo

Chinese Academy of Social Sciences (CASS) - Center for Chinese Agricultural Policy (CCAP) ( email )

Building 917, Datun Road
Beijing 100101
China

Linxiu Zhang

Chinese Academy of Sciences - Center for Chinese Agricultural Policy ( email )

Anwai, Beijing, 100101
China

Sean Sylvia (Contact Author)

Renmin University of China - School of Economics ( email )

No. 59, Zhongguancun Street
Beijing, Beijing 100080
China

Yaojiang Shi

Shaanxi Normal University ( email )

Chang'an Chang'an District
199 South Road
Xi'an, Shaanxi Province 710062
China

Patricia Foo

Stanford University ( email )

Stanford, CA 94305
United States

Qiran Zhao

Leibniz Institute of Agricultural Development in Transition Economies (IAMO) ( email )

Theodor-Lieser-Str.2
Halle, 06120
Germany

Reynaldo Martorell

Emory University ( email )

201 Dowman Drive
Atlanta, GA 30322
United States

Alexis Medina

Stanford University ( email )

Stanford, CA 94305
United States

Scott Rozelle

Stanford University - Freeman Spogli Institute of International Studies ( email )

Stanford, CA 94305
United States

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