Abstract：
Ethiopia has made great strides in improving population health but sustaining health system and population health improvements in the current fiscal environment is challenging. Provider payment, as a function of purchasing, is a tool to use limited health resources better. This study describes the design and implementation of Ethiopia\'s provider payment mechanisms (PPMs) and how they influence health system objectives and contribute to universal health coverage goals. The research team adapted the framework and analytical tools of the Joint Learning Network for Universal Health Coverage guide for assessing PPMs. Data were collected through literature review and key informant interviews with 11 purchasers and 17 health care providers. Content analysis was used to describe PPM design and implementation arrangements, and thematic analysis was used to distill effects on equity in resource distribution and access to care, efficiency, quality of care, and financial sustainability. The study revealed the PPMs had positive and negative consequences. Line-item budgets were perceived to be predictable and sustainable but had little effect on efficiency and provider performance. Fee-for-service was perceived to have negative effects on efficiency and financial sustainability but viewed positively on its ability to incentivize quality health services. Capitation and performance-based financing effects were viewed positively on equity in distribution of resources and quality respectively, but both were perceived negatively on their high administrative burden to providers. Ethiopia may consider a more nuanced approach to design blended provider payment to mitigate negative consequences while providing incentives for better quality of care and efficiency.
摘要：
埃塞俄比亚在改善人口健康方面取得了长足的进步，但在当前的财政环境中维持卫生系统和人口健康的改善具有挑战性。提供商付款,作为购买的功能，是更好地利用有限卫生资源的工具。这项研究描述了埃塞俄比亚提供者支付机制（PPM）的设计和实施，以及它们如何影响卫生系统目标并有助于实现全民健康覆盖目标。研究小组调整了《全民健康覆盖联合学习网络指南》的框架和分析工具，用于评估PPMs。通过文献综述和对11名购买者和17名医疗保健提供者的关键线人访谈收集数据。内容分析用于描述PPM设计和实施安排，并使用专题分析来提炼出对资源分配和获得护理的公平性的影响，效率,护理质量,和财务可持续性。研究表明，PPM具有积极和消极的后果。项目预算被认为是可预测和可持续的，但对效率和提供者业绩影响不大。收费服务被认为对效率和财务可持续性有负面影响，但对其激励优质卫生服务的能力持积极态度。分别对资源分配公平性和质量公平性给予了积极评价，但两者都被认为是负面的，因为他们给提供者带来了很高的行政负担。埃塞俄比亚可能会考虑采用更细微的方法来设计混合提供者付款，以减轻负面影响，同时为提高护理质量和效率提供激励。
