The Long Run Impact of Temporary Incentives on Healthworker Performance in Argentina

Last registered on October 19, 2016
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Pre-Trial

Trial Information

General Information

Title
The Long Run Impact of Temporary Incentives on Healthworker Performance in Argentina
RCT ID
AEARCTR-0001610
Initial registration date
October 19, 2016

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
October 19, 2016, 2:53 PM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

Country
Argentina
Region
Latin America

Primary Investigator

Name
PAUL GERTLER
Affiliation
University of California, Berkeley
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Other Primary Investigator(s)

PI Name
Christel Vermeersch
PI Affiliation
The World Bank
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PI Name
Paula Giovagnoli
PI Affiliation
The World Bank
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PI Name
Pablo Celhay
PI Affiliation
Pontificia Universidad Católica de Chile
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Additional Trial Information

Status
Completed
Start date
2009-01-01
End date
2012-12-31
Keywords
Health
Additional Keywords
Healthworker performance, Incentives, Medical care productivity
JEL code(s)
I11, I13, I15
Secondary IDs
Abstract
The adoption of new clinical practice patterns by medical care providers is often challenging, even when they are believed to be both efficacious and profitable. This paper uses a randomized field experiment to examine the effects of temporary financial incentives paid to medical care clinics for the initiation of prenatal care in the first trimester of pregnancy. The rate of early initiation of prenatal care was 34% higher in the treatment group than in the control group while the incentives were being paid, and this effect persisted at least 24 months or more after the incentives ended. These results are consistent with a model where the incentives enable providers to address the fixed costs of overcoming organizational inertia in innovation, and suggest that temporary incentives may be effective at motivating improvements in long run provider performance at a substantially lower cost than permanent incentives.
External Link(s)
Evaluation Summary on J-PAL Website

Registration Citation

Citation
Celhay, Pablo et al. 2016. "The Long Run Impact of Temporary Incentives on Healthworker Performance in Argentina." AEA RCT Registry. October 19. https://doi.org/10.1257/rct.1610-1.0
Former Citation
Celhay, Pablo et al. 2016. "The Long Run Impact of Temporary Incentives on Healthworker Performance in Argentina." AEA RCT Registry. October 19. https://www.socialscienceregistry.org/trials/1610/history/11347
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Experimental Details

Interventions

Intervention(s)
Prior to the intervention period, the province paid facilities $40 ARS for each prenatal visit regardless of when it occurred or whether it was the first or a subsequent visit. During the intervention period the fee paid to treatment clinics was increased to $120 ARS for 1st visits that occurred before week 13, but remained at $40 ARS for subsequent visits. After that, the intervention period fees reverted to the original payment of $40 ARS for all visits. The modified fee structure was implemented for 8 months.
Intervention (Hidden)
Intervention Start Date
2010-05-01
Intervention End Date
2010-12-31

Primary Outcomes

Primary Outcomes (end points)
Timing of first prenatal visit (# weeks pregnant), Clinic outreach activities, Birth weight
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
We test the effects of temporary incentives paid to clinics for early initiation of prenatal care using a field experiment conducted with Plan Nacer, in primary care clinics in the Province of Misiones. The experiment randomized temporary financial incentives to primary health care clinics in which treatment clinics were paid a 200% premium for early initiation of care.
Experimental Design Details
Randomization Method
Randomization was done simulating single random sampling in an excel sheet.
Randomization Unit
Clinics
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
37 clinics
Sample size: planned number of observations
Given that the number of women who visit a clinic can not be planned, and due to the small number of clusters in the experiment, the researchers did not plan for # of observations. Rather, they planed to conduct a series of robustness checks to ensure the achieved sample size held adequate statistical power.
Sample size (or number of clusters) by treatment arms
18 treatment clinics (modified fee schedule).
19 control clinics.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
IRB Approval Date
IRB Approval Number
Analysis Plan

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
Yes
Intervention Completion Date
December 31, 2010, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
December 31, 2012, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
36 clusters (clinics). 1 clinic closed prior to implementation.
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
2,775 women.
Final Sample Size (or Number of Clusters) by Treatment Arms
17 treatment clinics; however, 3 did not receive the treatment. 19 control clinics; however, 1 received the treatment.
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Abstract
This paper uses a randomized field experiment to examine the effects of temporary financial incentives paid to medical care clinics for the initiation of prenatal care in the first trimester of pregnancy.
Citation
Celhay, Pablo, Paul Gertler, Paula Giovagnoli, and Christel Vermeersch. "Long Run Effects of Temporary Incentives on Medical Care Productivity in Argentina." NBER Working Paper No. 21361, July 2015.
URL
https://www.povertyactionlab.org/sites/default/files/publications/3372%20Performance%20Incentives%20Healthcare%20Workers%20Argentina.pdf

Reports & Other Materials