This paper presents case studies of provider payment systems in the Kyrgyz Republic, Nigeria, and Zambia that link a quality improvement initiative with provider payment. It documents these programs’ experience with design and implementation and lessons learned for other health care payers seeking to improve quality at the point of care through redesign of a provider payment system.
There are multiple ways to design and implement provider payment systems that align incentives so as to encourage high quality of maternal health services. The architects of future provider payment programs should consider how certain design features of the system will or will not incentivize providers in the specific context to deliver high-quality health services. Considering what is feasible to implement in the immediate to medium term will also guide mechanism selection.
The experiences of the Kyrgyz Republic, Nigeria, and Zambia demonstrate ways to use financial incentives to motivate health workers and managers to each do their part to improve quality at the point of care. Frequent quality measurement, with results tied to a provider payment, was a design feature common to all three cases. While financial incentives in the provider payment mechanism was the element that gave the quality improvement initiative “teeth,” a number of system changes occurred in the process of implementing payment mechanisms that are linked to high quality. Redesigning the conventional provider payment system can better align payment with the types of health system outputs and outcomes that policymakers and quality of care advocates desire. However, poor program management can easily become a bottleneck and needs close monitoring.
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