Tajikistan - Feasibility Study for Results-Based Financing (RBF) In the Health Sector

The purpose of this study is to examine the feasibility of introducing Results-Based Financing (RBF) in Tajikistan's health sector. Several countries have experience with RBF in low-income settings, and lessons learned can be interesting for Tajikistan. Technically, RBF is a retrospective provider payment that can be designed to reimburse providers for contractually defined services and specific compliance targets, including for efficiency and quality targets. In Tajikistan RBF will be linked to ongoing provider payment reforms. Therefore, the chapter also provides a brief overview on provider payment mechanisms and experience with provider payment reforms and treatment patterns from middle- and higher-income countries. The objective of this feasibility study is to propose a sustainable RBF pilot program for two oblasts (Khatlon and Sughd), to cost-effectively improve maternal and child health (MCH) outcomes. The study aims to inform the health sector strategy and help the Government and partners to effectively design and use RBF mechanisms at three potential levels. First, the fiscal transfer from the central government to oblasts (regions) and rayons (districts) could be adjusted to include a bonus payment based on specific results achieved. Second, the provider payment method from oblast health fund pools to hospitals and outpatient facilities could reward providers based on results indicators. Third, a performance payment could be added to salaries paid to staff working in health facilities. It is expected that such a three-pronged approach could reinforce the financial incentive set through RBF to staff working in the administration and provision of care. If the staff responds to these incentives, then this could lead to better management in oblast and rayons, improved availability of financial resources and medical material in health facilities, and better treatment of patients. Combined, these behavioral changes will ultimately lead to better health results, including improved quality of care and in the longer-run improved health status.

Bibliographic Details

Main Author:	World Bank
Language:	English
Published:	World Bank 2010-03-31
Subjects:	ADMINISTRATIVE COSTS, ANTENATAL CARE, APPROPRIATE INCENTIVES, AVAILABILITY OF DRUGS, BASIC HEALTH SERVICES, BEDS, BEHAVIOR CHANGE, BLOCK GRANTS, BUDGET CEILING, BUDGET INCREASE, CAPITATION, CAPITATION PAYMENT, CAPITATION PAYMENTS, CAPITATION SYSTEM, CARE PERFORMANCE, CENTRAL BUDGET, CHILD CARE, CHILD HEALTH, CHILD HEALTH CARE, CHILD MORTALITY, CHILD MORTALITY RATES, CHRONIC DISEASES, CHRONIC MALNUTRITION, CLEANLINESS, CLINICAL INDICATORS, CLINICS, CONTRACTS WITH PROVIDERS, DEATH RATES, DEATHS, DECISION MAKING, DELIVERY SYSTEM, DOCTORS, DRUGS, ECONOMIC ANALYSIS, EQUITY IN ACCESS, EXERCISES, EXPENDITURES, FAMILY PLANNING, FEE-FOR-SERVICE, FEE-FOR-SERVICE PAYMENT, FINANCIAL BARRIERS, FINANCIAL IMPACT, FINANCIAL INCENTIVE, FINANCIAL INCENTIVES, FINANCIAL INFORMATION, FINANCIAL MANAGEMENT, FINANCIAL PRESSURE, FINANCIAL RESOURCES, FINANCIAL RISK, FINANCIAL SITUATION, GLOBAL BUDGETS, GLOBAL DEVELOPMENT, GROSS DOMESTIC PRODUCT, HEALTH BUDGETS, HEALTH CARE CENTERS, HEALTH CARE DELIVERY, HEALTH CARE DURING PREGNANCY, HEALTH CARE FACILITIES, HEALTH CARE FACILITY, HEALTH CARE FINANCING, HEALTH CARE PROVIDERS, HEALTH CARE SERVICES, HEALTH CARE WORKERS, HEALTH CENTERS, HEALTH EXPENDITURE, HEALTH EXPENDITURES, HEALTH FACILITIES, HEALTH FINANCING, HEALTH FINANCING REFORM, HEALTH FOR ALL, HEALTH INDICATORS, HEALTH INFORMATION, HEALTH INFORMATION SYSTEM, HEALTH MANAGEMENT, HEALTH ORGANIZATION, HEALTH OUTCOME INDICATORS, HEALTH OUTCOMES, HEALTH PROJECT, HEALTH PROMOTION, HEALTH RESULTS, HEALTH SECTOR, HEALTH SERVICE, HEALTH SERVICE PROVIDERS, HEALTH SERVICES, HEALTH SPECIALIST, HEALTH SPENDING, HEALTH STATUS, HEALTH SYSTEM, HEALTH SYSTEMS, HEALTH WORKERS, HEALTH WORKFORCE, HEALTHCARE, HIV, HOSPITAL, HOSPITAL ADMISSION, HOSPITAL CARE, HOSPITAL DISCHARGE, HOSPITAL MANAGERS, HOSPITALIZATION, HOSPITALS, HOUSEHOLD LEVEL, HR, HUMAN DEVELOPMENT, IMMUNIZATION, INCENTIVE PAYMENTS, INCOME, INCOME COUNTRIES, INCOME GROUPS, INDIVIDUAL HEALTH, INFANT, INFANT DEATH, INFANT MORTALITY, INFANT MORTALITY RATE, INFANTS, INFORMAL PAYMENTS, INFORMATION CAMPAIGNS, INFORMATION SYSTEMS, INPATIENT ADMISSION, INTEGRATION, IODINE DEFICIENCY, LABORATORY SERVICES, LEGAL FRAMEWORK, LIFE EXPECTANCY, LIVE BIRTHS, LIVING STANDARDS, LOCAL AUTHORITIES, LOCAL GOVERNMENTS, LOW BIRTH WEIGHT, LOW INCOME, LOW-INCOME COUNTRIES, LOW-INCOME COUNTRY, LOW-INCOME SETTINGS, MANAGED CARE, MANAGED CARE PLANS, MATERNAL MORTALITY, MATERNAL MORTALITY RATE, MATERNAL MORTALITY RATIO, MEDICAL DATA, MEDICAL EQUIPMENT, MEDICAL EXAMINATIONS, MEDICAL RECORDS, MEDICAL RESOURCES, MEDICAL STATISTICS, MEDICAL SUPPLIES, MEDICINES, MILLENNIUM DEVELOPMENT GOALS, MINISTRY OF HEALTH, MORTALITY, MOTHER, NATIONAL GOVERNMENT, NATIONAL HEALTH, NATIONAL HEALTH SERVICE, NATIONAL LEVEL, NEEDS ASSESSMENT, NUTRITION, ORAL REHYDRATION THERAPY, OUTPATIENT CARE, OUTPATIENT SERVICES, PATIENT, PATIENT SATISFACTION, PATIENT SURVEYS, PATIENTS, PEDIATRICS, PEER PRESSURE, PHARMACY, PHYSICIAN, PHYSICIANS, POCKET PAYMENTS, POOR HEALTH, POPULATION SIZE, PRACTITIONERS, PREGNANCY, PREGNANT WOMEN, PRENATAL CARE, PREVENTIVE CARE, PRIMARY HEALTH CARE, PRIVATE CLINICS, PROFESSIONAL ASSOCIATIONS, PROGRESS, PROVIDER PAYMENT, PROVISION OF CARE, PROVISION OF HEALTH CARE, PUBLIC ADMINISTRATION, PUBLIC EXPENDITURE, PUBLIC HEALTH, PUBLIC HEALTH EXPENDITURE, PUBLIC HEALTH SERVICES, PUBLIC HOSPITALS, PUBLIC SECTOR, QUALITY IMPROVEMENT, QUALITY OF CARE, QUALITY OF HEALTH, QUALITY OF HEALTH CARE, QUALITY OF SERVICES, REFERRALS, REMITTANCES, REPRODUCTIVE HEALTH, RESOURCE ALLOCATION, RESOURCE CONSTRAINTS, RESOURCE USE, RISK FACTORS, RURAL AREAS, SERVICE DELIVERY, SERVICE PROVISION, SOCIAL SECURITY, SURGERY, TREATMENTS, TUBERCULOSIS, UNDER FIVE MORTALITY, VACCINATION, VISITS, WOMENS HEALTH, WOMENS HEALTH CARE, WORKERS, WORLD HEALTH ORGANIZATION,
Online Access:	http://www-wds.worldbank.org/external/default/main?menuPK=64187510&pagePK=64193027&piPK=64187937&theSitePK=523679&menuPK=64187510&searchMenuPK=64187283&siteName=WDS&entityID=000333038_20100401003318 https://hdl.handle.net/10986/2838
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