Attributes of funding flows and quality of maternal health services in a mixed provider payment system: A cross‐sectional survey of 108 healthcare providers in Indonesia

• Published date: 01 June 2023
• Author: Dorit Talia Stein,Mukhammad F. Rakhmadi,Arin Dutta,Jorge I. Ugaz
• Date: 01 June 2023
• DOI: http://doi.org/10.1002/wmh3.545

Received: 8 December 2021

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Revised: 2 May 2022

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Accepted: 8 July 2022

DOI: 10.1002/wmh3.545

ORIGINAL ARTICLE

Attributes of funding flows and quality of

maternal health services in a mixed provider

payment system: A cross‐sectional survey of

108 healthcare providers in Indonesia

Dorit Talia Stein

1,2

|Mukhammad F. Rakhmadi

3

|

Arin Dutta

2,4

|Jorge I. Ugaz

2

1

Department of Global Health and

Population, Harvard T. H. Chan School of

Public Health, Boston, Massachusetts, USA

2

Palladium, Health Policy Plus Project,

Washington, District of Columbia, USA

3

Palladium, Health Policy Plus Project,

Jakarta, Indonesia

4

Asian Development Bank, Manila,

Philippines

Correspondence

Jorge I. Ugaz, Palladium, 1331 Pennsylvania

Ave NW #600, Washington, DC 20004, USA.

Email: jorge.ugaz@thepalladiumgroup.com

Funding information

United States Agency for International

Development, Grant/Award Number:

Cooperative Agreement No. OAA‐A‐15‐

00051

Abstract

Strategic purchasing of health services requires developing

a coherent set of incentives across financing sources. In

many countries, including Indonesia, healthcare providers

engage with multiple financing sources. It is not well known

how multiple funding flows in these mixed provider payment

systems may interact at the facility level to influence

provider behavior, quality of care, and ultimately health

outcomes. Our study explored the association between

facility capacity to provide high‐quality maternal and new-

born care at delivery and various attributes of facility

funding, including funding flexibility, sufficiency of funds to

cover direct costs, predictability of funds in timing and

amount, and facility autonomy to make management

decisions (decision space). We used survey data collected

from primary and secondary maternal healthcare providers

(n= 108) across eight provinces in Indonesia. We con-

structed a technical quality index that measures facility

capacity to provide high‐quality delivery care and several

financing measures that summarize provider perceptions of

flexibility, sufficiency, predictability of fund flows, and

provider decision space. We found a statistically significant

association between the decision space index score and the

technical quality index score among hospitals and public

primary care providers. One additional point on the decision

space index was associated with an additional 0.15

(p= 0.021; 95% confidence interval: 0.024–0.275) on the

quality index score after controlling for provider character-

istics and geographic location. Our findings suggest that

increasing facility autonomy to make management deci-

sions may be one avenue for improving facility capacity to

provide high‐quality care in systems where providers deal

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