Pay for Performance (P4P) in Health
Country of Operation
- Action for HealthNot-for-profit
Target income level
- Bottom 20%
SummaryThe P4P (Payment for Performance) Program in Cambodia facilitates the access of quality healthcare for the poor by subsidizing health care costs at affordable rates for the poor and providing incentive payments to contracted health care providers and patients.
In Cambodia, health service utilization at public facilities is low at 21% of the population seeking services. The purpose of implementation of P4P is to improve the accessibility, availability and quality of the services of reproductive health, family planning, child health, sanitation and nutrition practices through the provision of incentive payment to both patients and health care providers.
Key program components
The mechanism of P4P is applied within the health equity fund (HEF) schemes and community-based health insurance (CBHI) schemes. The two are health care financing schemes implemented by non-government organizations to purchase health services for the poor and vulnerable groups. HEF schemes facilitate access to quality health care services for the poor by paying them to purchase health care and providing them with transportation costs, food allowance during hospitalization and cash for funerals in case of death; the CBHI scheme provides access to quality health care services by allowing the scheme beneficiaries to pay premium at subsidized prices that are affordable for the poor before they are entitled to access medical and non-medical benefit packages. The P4P program contracts public health facilities to negotiate payments for service fees, lab, and hospital stay when the patients come to the hospital for inpatient and outpatient care. The program sets 7 key indicators and targeted measurements for the contracted public facilities: the number of poor and/or poor families identified, number of the poorest patients coming to use services, increased number of the poorest patients accessing the public facilities, number of poorest patients with improvement in health seeking behaviors, improved quality health care services, increased bed occupation rate in the outpatient department, and decreased mortality and morbidity rates among the identified poorest families. Some monitoring methods such as checklists, surveys and reviews are used to track progress of the health facilities. The incentive payment is based on the specific targets that public health facilities can achieve.