Transcript Implementation of Pharmaceutical Pricing and Reimbursement Reform

Bringing it all together:
Designing and
Implementing RBF
Benjamin Loevinsohn
World Bank
October 2008
A Few Thoughts to Start
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Don’t Panic: RBF has worked in difficult
situations, not everything has to be perfect, be
creative!
Be Systematic: Write things down in a
contract and a manual/plan/guide
The Limits of Planning: Endless planning and
analysis can get in the way of action & learning
Humility: a) don’t be too sure of things
b) knowledge must be larger than our experience
c) give people at local levels sufficient autonomy
d) keep learning, evaluating, adapting
Conceptually, RBF is Simple
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An objective with clear indicators
Measurement of the indicators
Payment linked to change in indicators
An entity to manage the process
Why RBF Ought to Work
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Focus on outputs/outcomes – NOT INPUTS
People respond predictably to rewards
Signals importance of indicators to the
recipient – people want to do a good job
Provides recognition of important work &
embarrassment if targets not achieved
Gets everyone to focus on measurement
issues and use of data for management
Possible Problems with RBF
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Is it effective? Does it work in the real world?
– points out need for rigorous evaluation.
Is it cost effective? – keep costs low
Does its effectiveness degrade over time? –
ensure that payments remain results based
Is it equitable? – means to target the poor
Unintended consequences? – evaluate
quality, equity, non-RBF indicators
Beyond Paying Health WorkersOther Opportunities for RBF
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BRAC approach to paying health educators
Recruiting district health managers on a
performance-based contract
CCT for institutional delivery
Making social marketing contracts
performance-based
Drug supply management contracts
LLIN distribution and use contracts
The RBF Implementation
Cycle
1. Diagnose
Problem
2. Determine Recipients
7. Develop
evaluation &
learning strategy
3. Design indicators &
targets, decide how to
measure them
6. Identify key
stakeholders
5. Establish entity
that will manage
RBF
4. Determine
payment
mechanism
THANK YOU!