Seminar: A Cluster Randomized Trial of Provider Incentives for Anemia Reduction in Rural China

Professor Scott Rozelle, Helen F. Farnsworth Senior Fellow at Stanford University, will give a seminar at USC on his recent paper "A Cluster Randomized Trial of Provider Incentives for Anemia Reduction in Rural China".

Scott Rozelle holds the Helen Farnsworth Endowed Professorship at Stanford University and is Senior Fellow and Professor in the Food Security and Environment Program and the Shorenstein Asia-Pacific Research Center, Freeman Spogli Institute (FSI) for International Studies. Dr. Rozelle's research focuses on China and is concerned with three general themes; a) agricultural policy, including the supply, demand, and trade in agricultural projects, b) issue involving rural resources, especially the management of water, the forests and cultivated land; and c) the economics of poverty—with an emphasis on the economics of education and health. Rozelle is the co-director of the Rural Education Action Project (REAP).

Dr. Rozelle's presentation in the 2011 USC Economics Conference can be viewed here.

Background: 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.

Methods: We conducted a cluster randomized trial of information, subsidies, and incentives for school principals to reduce anemia among fourth and fifth grade students in 72 randomlyselected rural primary schools across northwest China. Our experiment included a control and three treatment arms: (1) an information arm in which principals received education 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. Students, parents, nursing teams, and survey enumerators were blind to arm assignment. Primary outcomes were student hemoglobin concentrations; secondary outcomes were behavioral responses to the interventions.

Findings: 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.

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

Funding: Funding was provided by the International Initiative for Impact Evaluation (3ie), the Leibniz Institute of Agricultural Development in Central and Eastern Europe (IAMO), Pfizer, and Stanford University (the China Fund at the Freeman Spogli Institute for International Studies,the Stanford Center for International Development, and the Presidential Fund for Innovation in International Studies).