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.
Url:
DOI: 10.1136/bmj.e4809
Links to Exploration step
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<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>
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<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>
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<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>
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<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>
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<contrib contrib-type="author" corresp="no"><name><surname>Medina</surname>
<given-names>Alexis</given-names>
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<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>
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<pub-date pub-type="collection"><year>2012</year>
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<volume>345</volume>
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<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>
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<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>
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<affiliation>Katholieke Universiteit Leuven, LICOS Centre for Institutions and Economic Performance, Leuven 3000, Belgium</affiliation>
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<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>
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