Abstract

Examining multiple funding flows to public healthcare providers in low- and middle-income settings (LMICs) - results from case studies in Burkina Faso, Kenya, Morocco, Nigeria, Tunisia and Vietnam

Dkhimi F, Honda A, Hanson K, Mbau R, Onwujekwe O, Phuong HT, Mathauer I, Akhnif HE, Jaouadi I, Kiendrébéogo J, Ezumah N, Kabia E, Barasa E
Health Policy Plan. 2023;38

Permenent descriptor

Provider payment methods are traditionally examined by appraising the incentive signals inherent in individual payment mechanisms. However, mixed payment arrangements, which result in multiple funding flows from purchasers to providers, could be better understood by applying a systems approach that assesses the combined effects of multiple payment streams on healthcare providers. Guided by the framework developed by Barasa, Mathauer, et al. (2021), this paper synthesises the findings from six country case studies that examined multiple funding flows and describes the potential effect of multiple payment streams on healthcare provider behaviour in low- and middle-income countries (LMICs). The qualitative findings from this study reveal the extent of undesirable provider behaviour occurring due to the receipt of multiple funding flows and explain how certain characteristics of funding flows can drive the occurrence of undesirable behaviours. Service and resource shifting occurred in most of the study countries; however, the occurrence of cost-shifting was less evident. The perceived adequacy of payment rates was found to be the strongest driver of provider behavior in the countries examined. The study results indicate that undesirable provider behaviours can have negative impacts of efficiency, equity, and quality in healthcare service provision. Further empirical studies are required to add to the evidence on this link. In addition, future research could explore how governance arrangements can be used to coordinate multiple funding flows, mitigate unfavourable consequences, and identify issues associated with the implementation of relevant governance measures.