Factors associated with overreporting based on community verification results in a performance-based financing program in Zimbabwe
Abstract Background While most Performance Based Financing (PBF) programs perform community verifications to confirm patients received reported services, many focus analysis and payment calculations on facility record verification due to their lower cost. Risk-based sampling can reduce the cost of c...
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BMC
2025-05-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-025-12599-8 |
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| author | Trina Gorman Pia Arce Gabrielle O’Malley Taurai Kambeu Brian Maponga Jabulani Mavudze Sinokuthemba Xaba Getrude Ncube Bernardo Hernandez |
| author_facet | Trina Gorman Pia Arce Gabrielle O’Malley Taurai Kambeu Brian Maponga Jabulani Mavudze Sinokuthemba Xaba Getrude Ncube Bernardo Hernandez |
| author_sort | Trina Gorman |
| collection | DOAJ |
| description | Abstract Background While most Performance Based Financing (PBF) programs perform community verifications to confirm patients received reported services, many focus analysis and payment calculations on facility record verification due to their lower cost. Risk-based sampling can reduce the cost of community verifications by targeting areas with the highest risk of overreporting but there is little research on the factors associated with risk to guide sampling decisions. Objective This study explores facility-level and district-level factors associated with overreporting within a PBF setting. Methods Using community verification data from a Voluntary Medical Male Circumcision (VMMC) program in Zimbabwe, we estimated two binary outcomes with generalized mixed effects models. Our primary outcome is a measure of overreporting, defined as when interviewed patients did not plausibly confirm receipt of the VMMC. Additionally, we assessed factors associated with patients who were selected but ultimately not interviewed. We employed inverse probability of treatment weighting to address non-response and bootstrapping-based multiple imputation to address missingness. Results We found that patients in the target age range, which were compensated at a higher price point, were less likely to be interviewed and over two times more likely to be classified as overreported compared to patients outside this age range (OR: 2.92, 95% CI: 2.38–3.59). Patients from outside the fixed health facility were more likely to be interviewed and less likely to be classified as overreported. In-person interviews as opposed to phone interviews appeared to be a worthwhile investment (OR: 1.61, 95% CI: 1.20–2.16). Conclusion We identified various factors that were associated with unsubstantiated VMMCs to inform risk-based sampling; however, our findings also suggest potential data fabrication. Programs should consider employing similar methods to reduce costs and increase the use of community verification data. |
| format | Article |
| id | doaj-art-ce510fbebeda4e9f8cbf667fc3cfaadc |
| institution | DOAJ |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj-art-ce510fbebeda4e9f8cbf667fc3cfaadc2025-08-20T03:22:04ZengBMCBMC Health Services Research1472-69632025-05-0125111510.1186/s12913-025-12599-8Factors associated with overreporting based on community verification results in a performance-based financing program in ZimbabweTrina Gorman0Pia Arce1Gabrielle O’Malley2Taurai Kambeu3Brian Maponga4Jabulani Mavudze5Sinokuthemba Xaba6Getrude Ncube7Bernardo Hernandez8Department of Global Health, University of WashingtonGorman ConsultingDepartment of Global Health, University of WashingtonPopulation Services InternationalPopulation Services InternationalPopulation Services InternationalThe Ministry of Health and Child CareThe Ministry of Health and Child CareSchool of Public Health, National Institute of Public Health of MexicoAbstract Background While most Performance Based Financing (PBF) programs perform community verifications to confirm patients received reported services, many focus analysis and payment calculations on facility record verification due to their lower cost. Risk-based sampling can reduce the cost of community verifications by targeting areas with the highest risk of overreporting but there is little research on the factors associated with risk to guide sampling decisions. Objective This study explores facility-level and district-level factors associated with overreporting within a PBF setting. Methods Using community verification data from a Voluntary Medical Male Circumcision (VMMC) program in Zimbabwe, we estimated two binary outcomes with generalized mixed effects models. Our primary outcome is a measure of overreporting, defined as when interviewed patients did not plausibly confirm receipt of the VMMC. Additionally, we assessed factors associated with patients who were selected but ultimately not interviewed. We employed inverse probability of treatment weighting to address non-response and bootstrapping-based multiple imputation to address missingness. Results We found that patients in the target age range, which were compensated at a higher price point, were less likely to be interviewed and over two times more likely to be classified as overreported compared to patients outside this age range (OR: 2.92, 95% CI: 2.38–3.59). Patients from outside the fixed health facility were more likely to be interviewed and less likely to be classified as overreported. In-person interviews as opposed to phone interviews appeared to be a worthwhile investment (OR: 1.61, 95% CI: 1.20–2.16). Conclusion We identified various factors that were associated with unsubstantiated VMMCs to inform risk-based sampling; however, our findings also suggest potential data fabrication. Programs should consider employing similar methods to reduce costs and increase the use of community verification data.https://doi.org/10.1186/s12913-025-12599-8Community verificationPerformance-based financingRisk-based samplingOverreportingPatient verification |
| spellingShingle | Trina Gorman Pia Arce Gabrielle O’Malley Taurai Kambeu Brian Maponga Jabulani Mavudze Sinokuthemba Xaba Getrude Ncube Bernardo Hernandez Factors associated with overreporting based on community verification results in a performance-based financing program in Zimbabwe BMC Health Services Research Community verification Performance-based financing Risk-based sampling Overreporting Patient verification |
| title | Factors associated with overreporting based on community verification results in a performance-based financing program in Zimbabwe |
| title_full | Factors associated with overreporting based on community verification results in a performance-based financing program in Zimbabwe |
| title_fullStr | Factors associated with overreporting based on community verification results in a performance-based financing program in Zimbabwe |
| title_full_unstemmed | Factors associated with overreporting based on community verification results in a performance-based financing program in Zimbabwe |
| title_short | Factors associated with overreporting based on community verification results in a performance-based financing program in Zimbabwe |
| title_sort | factors associated with overreporting based on community verification results in a performance based financing program in zimbabwe |
| topic | Community verification Performance-based financing Risk-based sampling Overreporting Patient verification |
| url | https://doi.org/10.1186/s12913-025-12599-8 |
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