2014年-世界发展银行全球_Verification_of_Performance_in_Results-Based_Financing_Programs___The_Case_of_Plan_Nacer_in_Argentina_50页_1mb

Summary of the Study: Verification of Performance in Results-Based Financing Programs – The Case of Plan Nacer in Argentina

Core Content

This study examines the verification process in results-based financing (RBF) programs, with a specific focus on Plan Nacer in Argentina. It aims to describe the methods used for performance verification, present the results, and discuss the challenges and lessons learned from this experience.

Plan Nacer, a national health insurance program, was designed to improve access to basic health services for pregnant women and children under six years of age, especially those without insurance coverage. It is one of the largest RBF mechanisms globally, and its verification process provides valuable insights into how such systems can be implemented and monitored effectively.

Main Objectives

• To analyze the verification mechanisms in Plan Nacer.
• To detail the major characteristics of the verification process.
• To draw lessons learned that can inform the design of verification in RBF programs in other countries.

Key Actors and Responsibilities

Verification Methodology

The verification process in Plan Nacer includes several key components:

• Beneficiary Enrollment Verification: Conducted monthly by the Central Executive Unit (UEC), checking for duplication and cross-referencing with other insurance databases.
• Counter-Verification: Performed every two months by a third party, ensuring data consistency and source validation.
• Tracer Verification: Conducted every four months by a third party, using a sample of clinical records and beneficiary signatures to assess performance against ten health indicators (tracers).
• Fund Use Verification: Ensures that provincial funds are used for the purchase of services, typically at the same facilities where tracers are verified.

Verification Results

• Beneficiary Enrollment Rejections:
  • In the first phase (9 provinces), the rejection rate dropped from 20% in the first year to 2.7% in the second year, and further to 0.1–1% in subsequent years.
  • The nationwide rollout started with rejection rates of 0.4–0.7%.
• Tracer Rejections:
  • In 2005, 25% of declared tracer records were rejected.
  • By 2012, this rate had slowed to approximately 5%.
• Adjustments and Fines:
  • Between 2004 and 2012, adjustments and fines based on verification accounted for 5.9% of gross transfers.
  • Total adjustments amounted to $8.3 million, while fines totaled $2.75 million.

Cost and Efficiency

• The cost of the third party verifier was $21.6 million between 2004 and 2012.
• More than half of the verifier costs were recovered through fines and adjustments.
• The sample size and team composition significantly influence verification costs.
• There is a tension between the UEC’s desire for broad verification and the third party’s interest in maintaining a manageable and representative sample.

Lessons Learned

• The third party verifier plays a crucial role in ensuring the accuracy of reporting and adjusting RBF payments accordingly.
• It functions as a mediator between the national government and the provinces, enhancing transparency and accountability.
• The federal structure of Argentina makes the use of a third party verifier particularly effective in managing intergovernmental relations.
• There is a need to balance the scope of verification with cost efficiency and the accuracy of data collection.

Conclusion

Plan Nacer demonstrates that a well-structured verification process is essential for the success of RBF mechanisms in health programs. The program's evolution over time, the decreasing error rates, and the role of the third party verifier highlight the importance of continuous monitoring, transparency, and the use of independent assessments to ensure the program’s effectiveness and sustainability. The findings from this study can be used to inform the design of similar RBF programs in other countries, especially those with federal structures.

Key Information

• Plan Nacer is a results-based financing program aimed at improving maternal and child health in Argentina.
• It was piloted in nine provinces and later expanded nationwide.
• Ten tracers are used to measure the program's impact and performance.
• The third party verifier is a key component in the verification process, providing an independent assessment.
• The verification process includes both enrollment checks and tracer assessments, with the latter being conducted every four months.
• The cost of verification is a significant factor in the overall program budget, but a substantial portion is recovered through adjustments and fines.

References and Appendices

• The study draws on the Plan Nacer Operations Manual and various country reports.
• Appendices include the organizational structure of the UEC, verification tasks related to beneficiary enrollment, and operational verification details.

This summary highlights the importance of verification in RBF programs and provides a comprehensive overview of the methods, results, and implications of the Plan Nacer verification process in Argentina.