Contracting for Health: Evidence from Cambodia
Authors
-
David
Clingingsmith
-
Michael
Kremer
-
Erik
Bloom
-
Benjamin
Loevinsohn
-
Indu
Bhushan
-
Elizabeth
King
-
Rathavuth
Hong
Website
http://
poverty-action.org/sites/default/files/Contracting_for_Health_6NOV06.pdf
Abstract
Distortions in both government and private fee-for-service healthcare provision are severe
in developing countries, leading many to question whether the large increases in health care
spending that many have proposed will have much impact. Cambodia recently tried a new
approach to service delivery by contracting out management of government health services
to NGOs in five districts that had been randomly made eligible for the approach. The
contracts specified targets for maternal and child health service improvement. Targeted
outcomes improved dramatically by about 0.5 standard deviations relative to comparison
districts. Changes in non-targeted outcomes were small. The program reduced provider
absence, increased supervisory visits by managers, and improved hospital care. There is
indirect evidence it improved health. The program involved increased public health
funding, but led to roughly offsetting reductions in private expenditure as residents in
treated districts switched from unlicensed drug sellers and traditional healers to government
clinics.
