Date and Time
January 11, 2012
1:30 PM - 3:00 PM

Availability
Open to the public
No RSVP required

Speaker
Grant Miller - Stanford University

Please note: All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.

Abstract:

Context: To study how misaligned supply-side incentives impede health programs in developing countries, we tested the impact of performance pay for anemia reduction in rural China. To the best of our knowledge, our study is the first to evaluate performance pay for actual health improvement.

Objective: To determine whether incentives for school principals have an impact on student anemia levels and academic performance.

Design: We conducted a cluster randomized trial of information, subsidies, and incentives for school principals to reduce anemia among students. Students, parents, nursing teams, and survey enumerators were blind to arm assignment. The study was conducted over the course of an academic year, lasting a total of 7 months.

Setting: 72 randomly-selected rural primary schools across northwest China. 

Participants: 3,553 fourth and fifth grade students aged 9 to 11. All fourth and fifth grade students in sample schools participated in the study.

Interventions: Our experiment included a control group with no intervention and three treatment arms: (1) an information arm in which principals received information about anemia; (2) a subsidy arm in which principals received information and unconditional subsidies; and (3) an incentive arm in which principals received information, subsidies, and financial incentives for reducing anemia among students.

Main Outcome Measures: Student hemoglobin concentrations.

Results: Mean student hemoglobin concentration rose by 0.13 g/dL (95% CI -0.07–0.34) in information schools, 0.08 g/dL (95% CI -0.12–0.27) in subsidy schools, and 0.19 g/dL (95% CI 0.01–0.38) in incentive schools relative to the control group. This increase in hemoglobin corresponded to a reduction in anemia prevalence (Hb < 11.5 g/dL) of 9-23% in incentive schools. Interactions with pre-existing complementary incentives for good test scores led to larger gains: 1.08 g/dL (95% CI 0.61–1.54) in information schools, 0.50 g/dL (95% CI 0.04–0.96) in subsidy schools, and 1.05 g/dL (95% CI 0.64–1.47) in incentive schools.

Conclusion: Financial incentives for health improvement were modestly effective. Understanding interactions with other motives and pre-existing incentives is critical.