Effectiveness of provider incentives for anaemia reduction in rural China: a cluster randomised trial
Identifieur interne : 000D87 ( Istex/Corpus ); précédent : 000D86; suivant : 000D88Effectiveness of provider incentives for anaemia reduction in rural China: a cluster randomised trial
Auteurs : Grant Miller ; Renfu Luo ; Linxiu Zhang ; Sean Sylvia ; Yaojiang Shi ; Patricia Foo ; Qiran Zhao ; Reynaldo Martorell ; Alexis Medina ; Scott RozelleSource :
- BMJ : British Medical Journal [ 1756-1833 ] ; 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. Trial registration number ISRCTN76158086.
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DOI: 10.1136/bmj.e4809
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Research, Chinese Academy of Sciences, Beijing 100101, China</mods:affiliation></affiliation></author><author><name sortKey="Zhang, Linxiu" sort="Zhang, Linxiu" uniqKey="Zhang L" first="Linxiu" last="Zhang">Linxiu Zhang</name><affiliation><mods:affiliation>Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China</mods:affiliation></affiliation></author><author><name sortKey="Sylvia, Sean" sort="Sylvia, Sean" uniqKey="Sylvia S" first="Sean" last="Sylvia">Sean Sylvia</name><affiliation><mods:affiliation>Department of Agricultural and Resource Economics, University of Maryland, College Park, MD 20742, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Northwest Socioeconomic Development Research Center, Northwest University, Xi’an 710127, China</mods:affiliation></affiliation></author><author><name sortKey="Shi, Yaojiang" sort="Shi, Yaojiang" uniqKey="Shi Y" 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USA</mods:affiliation></affiliation><affiliation><mods:affiliation>National Bureau of Economic Research, Cambridge, MA 02138, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: ngmiller@stanford.edu</mods:affiliation></affiliation></author><author><name sortKey="Luo, Renfu" sort="Luo, Renfu" uniqKey="Luo R" first="Renfu" last="Luo">Renfu Luo</name><affiliation><mods:affiliation>Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China</mods:affiliation></affiliation></author><author><name sortKey="Zhang, Linxiu" sort="Zhang, Linxiu" uniqKey="Zhang L" first="Linxiu" last="Zhang">Linxiu Zhang</name><affiliation><mods:affiliation>Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China</mods:affiliation></affiliation></author><author><name sortKey="Sylvia, Sean" sort="Sylvia, Sean" uniqKey="Sylvia S" first="Sean" last="Sylvia">Sean Sylvia</name><affiliation><mods:affiliation>Department of Agricultural and Resource Economics, University of Maryland, College Park, MD 20742, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Northwest Socioeconomic Development Research Center, Northwest University, Xi’an 710127, China</mods:affiliation></affiliation></author><author><name sortKey="Shi, Yaojiang" sort="Shi, Yaojiang" uniqKey="Shi Y" first="Yaojiang" last="Shi">Yaojiang Shi</name><affiliation><mods:affiliation>Northwest Socioeconomic Development Research Center, Northwest University, Xi’an 710127, China</mods:affiliation></affiliation></author><author><name sortKey="Foo, Patricia" sort="Foo, Patricia" uniqKey="Foo P" first="Patricia" last="Foo">Patricia Foo</name><affiliation><mods:affiliation>Department of Economics, Stanford University</mods:affiliation></affiliation><affiliation><mods:affiliation>School of Medicine, Stanford University</mods:affiliation></affiliation></author><author><name sortKey="Zhao, Qiran" sort="Zhao, Qiran" uniqKey="Zhao Q" first="Qiran" last="Zhao">Qiran Zhao</name><affiliation><mods:affiliation>Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China</mods:affiliation></affiliation><affiliation><mods:affiliation>Leibniz Institute of Agricultural Development in Central and Eastern Europe (IAMO), Halle (Saale) 06120, Germany</mods:affiliation></affiliation></author><author><name sortKey="Martorell, Reynaldo" sort="Martorell, Reynaldo" uniqKey="Martorell R" first="Reynaldo" last="Martorell">Reynaldo Martorell</name><affiliation><mods:affiliation>Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA</mods:affiliation></affiliation></author><author><name sortKey="Medina, Alexis" sort="Medina, Alexis" uniqKey="Medina A" first="Alexis" last="Medina">Alexis Medina</name><affiliation><mods:affiliation>Freeman Spogli Institute for International Studies, Stanford University</mods:affiliation></affiliation></author><author><name sortKey="Rozelle, Scott" sort="Rozelle, Scott" uniqKey="Rozelle S" first="Scott" last="Rozelle">Scott Rozelle</name><affiliation><mods:affiliation>Freeman Spogli Institute for International Studies, Stanford University</mods:affiliation></affiliation><affiliation><mods:affiliation>Katholieke Universiteit Leuven, LICOS Centre for Institutions and Economic Performance, Leuven 3000, Belgium</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">BMJ : British Medical Journal</title><title level="j" type="abbrev">BMJ</title><idno type="eISSN">1756-1833</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date type="published" when="2012">2012</date><biblScope unit="volume">345</biblScope></imprint></series><idno type="istex">FFDB5E52B8EB84FA9E3A112CE8577A0D9C4F9F7E</idno><idno type="DOI">10.1136/bmj.e4809</idno><idno type="href">bmj-345-bmj-e4809.pdf</idno><idno type="ArticleID">milg001892</idno><idno type="local">bmj;345/jul27_1/e4809</idno></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="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. Trial registration number ISRCTN76158086.</div></front></TEI><istex><corpusName>bmj</corpusName><author><json:item><name>Grant Miller</name><affiliations><json:string>Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford Medical School, Stanford University, Stanford, CA 94305, USA</json:string><json:string>National Bureau of Economic Research, Cambridge, MA 02138, USA</json:string><json:string>E-mail: ngmiller@stanford.edu</json:string></affiliations></json:item><json:item><name>Renfu Luo</name><affiliations><json:string>Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China</json:string></affiliations></json:item><json:item><name>Linxiu Zhang</name><affiliations><json:string>Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China</json:string></affiliations></json:item><json:item><name>Sean Sylvia</name><affiliations><json:string>Department of Agricultural and Resource Economics, University of Maryland, College Park, MD 20742, USA</json:string><json:string>Northwest Socioeconomic Development Research Center, Northwest University, Xi’an 710127, China</json:string></affiliations></json:item><json:item><name>Yaojiang Shi</name><affiliations><json:string>Northwest Socioeconomic Development Research Center, Northwest University, Xi’an 710127, China</json:string></affiliations></json:item><json:item><name>Patricia Foo</name><affiliations><json:string>Department of Economics, Stanford University</json:string><json:string>School of Medicine, Stanford University</json:string></affiliations></json:item><json:item><name>Qiran Zhao</name><affiliations><json:string>Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China</json:string><json:string>Leibniz Institute of Agricultural Development in Central and Eastern Europe (IAMO), Halle (Saale) 06120, Germany</json:string></affiliations></json:item><json:item><name>Reynaldo Martorell</name><affiliations><json:string>Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA</json:string></affiliations></json:item><json:item><name>Alexis Medina</name><affiliations><json:string>Freeman Spogli Institute for International Studies, Stanford University</json:string></affiliations></json:item><json:item><name>Scott Rozelle</name><affiliations><json:string>Freeman Spogli Institute for International Studies, Stanford University</json:string><json:string>Katholieke Universiteit Leuven, LICOS Centre for Institutions and Economic Performance, Leuven 3000, Belgium</json:string></affiliations></json:item></author><articleId><json:string>milg001892</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><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. Trial registration number ISRCTN76158086.</abstract><qualityIndicators><score>8.5</score><pdfVersion>1.4</pdfVersion><pdfPageSize>595.276 x 841.89 pts (A4)</pdfPageSize><refBibsNative>false</refBibsNative><keywordCount>0</keywordCount><abstractCharCount>2316</abstractCharCount><pdfWordCount>5972</pdfWordCount><pdfCharCount>42104</pdfCharCount><pdfPageCount>10</pdfPageCount><abstractWordCount>342</abstractWordCount></qualityIndicators><title>Effectiveness of provider incentives for anaemia reduction in rural China: a cluster randomised trial</title><genre><json:string>research-article</json:string></genre><host><volume>345</volume><publisherId><json:string>bmj</json:string></publisherId><genre><json:string>journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1756-1833</json:string></eissn><title>BMJ : British Medical 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resp="ISTEX-API">ISTEX-API (INIST-CNRS)</name></respStmt></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>British Medical Journal Publishing Group</publisher><availability status="free"><p>Open Access</p></availability><date>2012</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Effectiveness of provider incentives for anaemia reduction in rural China: a cluster randomised trial</title><author xml:id="author-1" corresp="yes"><persName><forename type="first">Grant</forename><surname>Miller</surname></persName><email>ngmiller@stanford.edu</email><note type="biography">associate professor</note><affiliation>associate professor</affiliation><affiliation>Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford Medical School, Stanford University, Stanford, CA 94305, USA</affiliation><affiliation>National Bureau of Economic Research, Cambridge, MA 02138, USA</affiliation></author><author xml:id="author-2"><persName><forename type="first">Renfu</forename><surname>Luo</surname></persName><note type="biography">associate professor</note><affiliation>associate professor</affiliation><affiliation>Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China</affiliation></author><author xml:id="author-3"><persName><forename type="first">Linxiu</forename><surname>Zhang</surname></persName><note type="biography">professor, deputy director</note><affiliation>professor, deputy director</affiliation><affiliation>Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China</affiliation></author><author xml:id="author-4"><persName><forename type="first">Sean</forename><surname>Sylvia</surname></persName><note type="biography">PhD candidate</note><affiliation>PhD candidate</affiliation><affiliation>Department of Agricultural and Resource Economics, University of Maryland, College Park, MD 20742, USA</affiliation><affiliation>Northwest Socioeconomic Development Research Center, Northwest University, Xi’an 710127, China</affiliation></author><author xml:id="author-5"><persName><forename type="first">Yaojiang</forename><surname>Shi</surname></persName><note type="biography">professor</note><affiliation>professor</affiliation><affiliation>Northwest Socioeconomic Development Research Center, Northwest University, Xi’an 710127, China</affiliation></author><author xml:id="author-6"><persName><forename type="first">Patricia</forename><surname>Foo</surname></persName><note type="biography">PhD candidate</note><affiliation>PhD candidate</affiliation><affiliation>Department of Economics, Stanford University</affiliation><affiliation>School of Medicine, Stanford University</affiliation></author><author xml:id="author-7"><persName><forename type="first">Qiran</forename><surname>Zhao</surname></persName><note type="biography">PhD candidate</note><affiliation>PhD candidate</affiliation><affiliation>Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China</affiliation><affiliation>Leibniz Institute of Agricultural Development in Central and Eastern Europe (IAMO), Halle (Saale) 06120, Germany</affiliation></author><author xml:id="author-8"><persName><forename type="first">Reynaldo</forename><surname>Martorell</surname></persName><note type="biography">professor</note><affiliation>professor</affiliation><affiliation>Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA</affiliation></author><author xml:id="author-9"><persName><forename type="first">Alexis</forename><surname>Medina</surname></persName><note type="biography">project manager</note><affiliation>project manager</affiliation><affiliation>Freeman Spogli Institute for International Studies, Stanford University</affiliation></author><author xml:id="author-10"><persName><forename type="first">Scott</forename><surname>Rozelle</surname></persName><note type="biography">Helen F Farnsworth senior fellow</note><affiliation>Helen F Farnsworth senior fellow</affiliation><affiliation>Freeman Spogli Institute for International Studies, Stanford University</affiliation><affiliation>Katholieke Universiteit Leuven, LICOS Centre for Institutions and Economic Performance, Leuven 3000, Belgium</affiliation></author></analytic><monogr><title level="j">BMJ : British Medical Journal</title><title level="j" type="abbrev">BMJ</title><idno type="eISSN">1756-1833</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date type="published" when="2012"></date><biblScope unit="volume">345</biblScope></imprint></monogr><idno type="istex">FFDB5E52B8EB84FA9E3A112CE8577A0D9C4F9F7E</idno><idno type="DOI">10.1136/bmj.e4809</idno><idno type="href">bmj-345-bmj-e4809.pdf</idno><idno type="ArticleID">milg001892</idno><idno type="local">bmj;345/jul27_1/e4809</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2012</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>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. Trial registration number ISRCTN76158086.</p></abstract></profileDesc><revisionDesc><change when="2012">Published</change><change xml:id="refBibs-istex" who="#ISTEX-API" when="2016-10-4">References added</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/FFDB5E52B8EB84FA9E3A112CE8577A0D9C4F9F7E/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">bmj</journal-id><journal-id journal-id-type="nlm-ta">BMJ</journal-id><journal-id journal-id-type="publisher-id">bmj</journal-id><journal-title>BMJ : British Medical Journal</journal-title><issn pub-type="epub">1756-1833</issn><publisher><publisher-name>British Medical Journal Publishing Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">milg001892</article-id><article-id pub-id-type="doi">10.1136/bmj.e4809</article-id><article-id pub-id-type="other">bmj;345/jul27_1/e4809</article-id><article-id pub-id-type="other">bmj;bmj.e4809</article-id><article-id pub-id-type="other">jul27_1</article-id><article-id pub-id-type="other">bmj.e4809</article-id><article-id pub-id-type="other">bmj.e4809</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>Effectiveness of provider incentives for anaemia reduction in rural China: a cluster randomised trial</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Miller</surname><given-names>Grant</given-names></name><role>associate professor</role><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Luo</surname><given-names>Renfu</given-names></name><role>associate professor</role><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Zhang</surname><given-names>Linxiu</given-names></name><role>professor, deputy director</role><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Sylvia</surname><given-names>Sean</given-names></name><role>PhD candidate</role><xref ref-type="aff" rid="aff4">4</xref><xref ref-type="aff" rid="aff5">5</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Shi</surname><given-names>Yaojiang</given-names></name><role>professor</role><xref ref-type="aff" rid="aff5">5</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Foo</surname><given-names>Patricia</given-names></name><role>PhD candidate</role><xref ref-type="aff" rid="aff6">6</xref><xref ref-type="aff" rid="aff7">7</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Zhao</surname><given-names>Qiran</given-names></name><role>PhD candidate</role><xref ref-type="aff" rid="aff3">3</xref><xref ref-type="aff" rid="aff8">8</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Martorell</surname><given-names>Reynaldo</given-names></name><role>professor</role><xref ref-type="aff" rid="aff9">9</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Medina</surname><given-names>Alexis</given-names></name><role>project manager</role><xref ref-type="aff" rid="aff10">10</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Rozelle</surname><given-names>Scott</given-names></name><role>Helen F Farnsworth senior fellow</role><xref ref-type="aff" rid="aff10">10</xref><xref ref-type="aff" rid="aff11">11</xref></contrib><aff id="aff1"><label>1</label>Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford Medical School, Stanford University, Stanford, CA 94305, USA</aff><aff id="aff2"><label>2</label>National Bureau of Economic Research, Cambridge, MA 02138, USA</aff><aff id="aff3"><label>3</label>Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China</aff><aff id="aff4"><label>4</label>Department of Agricultural and Resource Economics, University of Maryland, College Park, MD 20742, USA</aff><aff id="aff5"><label>5</label>Northwest Socioeconomic Development Research Center, Northwest University, Xi’an 710127, China</aff><aff id="aff6"><label>6</label>Department of Economics, Stanford University</aff><aff id="aff7"><label>7</label>School of Medicine, Stanford University</aff><aff id="aff8"><label>8</label>Leibniz Institute of Agricultural Development in Central and Eastern Europe (IAMO), Halle (Saale) 06120, Germany</aff><aff id="aff9"><label>9</label>Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA</aff><aff id="aff10"><label>10</label>Freeman Spogli Institute for International Studies, Stanford University</aff><aff id="aff11"><label>11</label>Katholieke Universiteit Leuven, LICOS Centre for Institutions and Economic Performance, Leuven 3000, Belgium</aff></contrib-group><author-notes><corresp>Correspondence to: G Miller <email>ngmiller@stanford.edu</email></corresp></author-notes><pub-date pub-type="collection"><year>2012</year></pub-date><pub-date pub-type="epub-original"><year>2012</year></pub-date><volume>345</volume><volume-id pub-id-type="other">345</volume-id><volume-id pub-id-type="other">345</volume-id><elocation-id>e4809</elocation-id><history><date date-type="accepted"><day>03</day><month>July</month><year>2012</year></date></history><permissions><copyright-statement>© Miller et al 2012</copyright-statement><copyright-year>2012</copyright-year><copyright-holder>Miller et al</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/"><p>This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: <ext-link xlink:href="http://creativecommons.org/licenses/by-nc/2.0/" ext-link-type="uri">http://creativecommons.org/licenses/by-nc/2.0/</ext-link> and <ext-link xlink:href="http://creativecommons.org/licenses/by-nc/2.0/legalcode" ext-link-type="uri">http://creativecommons.org/licenses/by-nc/2.0/legalcode</ext-link>.</p></license></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="bmj-345-bmj-e4809.pdf"></self-uri><abstract><p><bold>Objectives</bold> To test the impact of provider performance pay for anaemia reduction in rural China. </p><p><bold>Design</bold> 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.</p><p><bold>Setting</bold> 72 randomly selected rural primary schools across northwest China.</p><p><bold>Participants</bold> 3553 fourth and fifth grade students aged 9-11 years. All fourth and fifth grade students in sample schools participated in the study.</p><p><bold>Interventions</bold> Sample schools were randomly assigned to a control group, with no intervention, or one of three treatment arms: (<italic>a</italic>) an information arm, in which principals received information about anaemia; (<italic>b</italic>) a subsidy arm, in which principals received information and unconditional subsidies; and (<italic>c</italic>) 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).</p><p><bold>Main outcome measures</bold> Student haemoglobin concentrations.</p><p><bold>Results</bold> 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.</p><p><bold>Conclusions</bold> Financial incentives for health improvement were modestly effective. Understanding interactions with other motives and pre-existing incentives is critical.</p><p><bold>Trial registration number</bold> <ext-link ext-link-type="isrctn" xlink:href="76158086">ISRCTN76158086</ext-link>.</p></abstract></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Effectiveness of provider incentives for anaemia reduction in rural China: a cluster randomised trial</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Effectiveness of provider incentives for anaemia reduction in rural China: a cluster randomised trial</title></titleInfo><name type="personal" displayLabel="corresp"><namePart type="given">Grant</namePart><namePart type="family">Miller</namePart><affiliation>Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford Medical School, Stanford University, Stanford, CA 94305, USA</affiliation><affiliation>National Bureau of Economic Research, Cambridge, MA 02138, USA</affiliation><affiliation>E-mail: ngmiller@stanford.edu</affiliation><description>associate professor</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Renfu</namePart><namePart type="family">Luo</namePart><affiliation>Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China</affiliation><description>associate professor</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Linxiu</namePart><namePart type="family">Zhang</namePart><affiliation>Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China</affiliation><description>professor, deputy director</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Sean</namePart><namePart type="family">Sylvia</namePart><affiliation>Department of Agricultural and Resource Economics, University of Maryland, College Park, MD 20742, USA</affiliation><affiliation>Northwest Socioeconomic Development Research Center, Northwest University, Xi’an 710127, China</affiliation><description>PhD candidate</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Yaojiang</namePart><namePart type="family">Shi</namePart><affiliation>Northwest Socioeconomic Development Research Center, Northwest University, Xi’an 710127, China</affiliation><description>professor</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Patricia</namePart><namePart type="family">Foo</namePart><affiliation>Department of Economics, Stanford University</affiliation><affiliation>School of Medicine, Stanford University</affiliation><description>PhD candidate</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Qiran</namePart><namePart type="family">Zhao</namePart><affiliation>Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China</affiliation><affiliation>Leibniz Institute of Agricultural Development in Central and Eastern Europe (IAMO), Halle (Saale) 06120, Germany</affiliation><description>PhD candidate</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Reynaldo</namePart><namePart type="family">Martorell</namePart><affiliation>Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA</affiliation><description>professor</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Alexis</namePart><namePart type="family">Medina</namePart><affiliation>Freeman Spogli Institute for International Studies, Stanford University</affiliation><description>project manager</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Scott</namePart><namePart type="family">Rozelle</namePart><affiliation>Freeman Spogli Institute for International Studies, Stanford University</affiliation><affiliation>Katholieke Universiteit Leuven, LICOS Centre for Institutions and Economic Performance, Leuven 3000, Belgium</affiliation><description>Helen F Farnsworth senior fellow</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>British Medical Journal Publishing Group</publisher><dateIssued encoding="w3cdtf">2012</dateIssued><copyrightDate encoding="w3cdtf">2012</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><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. 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See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.</accessCondition><recordInfo><recordContentSource>BMJ</recordContentSource><recordOrigin>Miller et al</recordOrigin></recordInfo></mods></metadata><annexes><json:item><original>true</original><mimetype>image/jpeg</mimetype><extension>jpeg</extension><uri>https://api.istex.fr/document/FFDB5E52B8EB84FA9E3A112CE8577A0D9C4F9F7E/annexes/jpeg</uri></json:item></annexes><enrichments><json:item><type>refBibs</type><uri>https://api.istex.fr/document/FFDB5E52B8EB84FA9E3A112CE8577A0D9C4F9F7E/enrichments/refBibs</uri></json:item></enrichments><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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