Contracting-Out Primary Health Care Services Using Performance-Based Payments: An Evaluation of the Honduras’ Experience

40 Pages Posted: 17 Jul 2015 Last revised: 22 Jul 2015

See all articles by Mercedes Vellez

Mercedes Vellez

University of Rome II Tor Vergata, Faculty of Economics, Department of Economics and Institutions (DEI); Center for the Study of State and Society (CEDES)

Date Written: January 1, 2015

Abstract

Honduras has recently contracted-out the provision of primary health care services to decentralized providers in order to expand health care coverage in rural areas. This paper evaluates the impact of contracting-out on health outputs and outcomes related to access, quality, and equity in health care. The impact evaluation design is quasi-experimental, and uses the propensity score matching method to select a control group of municipalities with public provision statistically comparable to those that contracted-out services. Estimates from a fixed effect model indicate that contracting-out was effective to increase access to health care, but there was no evidence of a significant impact on quality of care. The positive effects on health care utilization were higher in municipalities with extremely-high poverty levels, indicating that contracting-out also improved equity in health care.

Keywords: contracting-out, access, quality, equity, infant mortality, propensity score matching

JEL Classification: C23, H44, I18

Suggested Citation

Vellez, Mercedes, Contracting-Out Primary Health Care Services Using Performance-Based Payments: An Evaluation of the Honduras’ Experience (January 1, 2015). Available at SSRN: https://ssrn.com/abstract=2631766 or http://dx.doi.org/10.2139/ssrn.2631766

Mercedes Vellez (Contact Author)

University of Rome II Tor Vergata, Faculty of Economics, Department of Economics and Institutions (DEI) ( email )

Via di Tor Vergata
Rome, Lazio 00133
Italy

Center for the Study of State and Society (CEDES) ( email )

Sanchez de Bustamante 27
Buenos Aires, C1173AAA
Argentina

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