PROVIDER PAYMENT IN HEALTH SYSTEM REFORMS: IMPACT, AUTONOMY, CAPACITY

Abstract

This thesis examines the impacts and implementations of provider payment as a policy tool to structure incentives towards cost-efficiency and quality improvement in developing countries. Using an analytical lens that intersects health economics and public administration, this thesis employs a diverse set of methods in four essays to answer two overarching research questions – (i) what are the policy impacts and implementation mechanisms of provider payment reforms in developing countries? and (ii) what are the pathways that distinguish optimal and sub-optimal reforms? Major shifts in the payment systems in developing countries from retrospective to prospective payment systems (PPSs) were examined by combining exploratory and inductive approaches at the beginning and following a hypothetico-deductive sequence towards the end. Overall, PPS reforms in developing countries have largely reduced cost and wastage. Its effective implementation hinges on having a functional design as well as having sufficient policy capacity and autonomy among the bureaucrats within a health system.