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
Date Written: January 1, 2015
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: Suggested Citation