Different Strokes for Different Folks? Experimental Evidence on the Effectiveness of Input and Output Incentive Contracts for Health Care Providers with Varying Skills - A Reproducibility and Replicability Assessment of Mohanan et al. (2021)

Lisa Bogler, Florian Neubauer, Julian Rose and Jörg Ankel-Peters

No 345, I4R Discussion Paper Series from The Institute for Replication (I4R)

Abstract: Mohanan et al. (2021a) test the effect of input and output incentive contracts for health providers on maternal and neonatal health outcomes using a randomized controlled trial in Karnataka, India. They find that both contract types led to a reduction in the probability of experiencing postpartum hemorrhage and that the input incentive contract did so more cost-effectively. The authors cautiously suggest heterogeneity by provider qualification for output contracts, claiming that providers with higher qualification performed better than those with lower qualification under the output incentive contract but not under the input incentive contract. We use the authors' reproduction package to replicate their results and to perform a series of robustness checks. The first claim regarding the effectiveness of both contract types holds in our robustness reproduction. The evidence for the paper's second-order heterogeneity claim is tentative and sensitive to how provider qualification is operationalized. The pre-analysis plan prespecifies heterogeneity by provider 'Qualifications' but does not define the measure; the published paper operationalizes skill/human capital more narrowly as advanced obstetric specialization (MBBS plus). Using an alternative operationalization of the broader preregistered qualification construct - MBBS-or-higher versus BAMS/other - yields negative interactions under both contract types. We interpret the difference as sensitivity to how the broader preregistered qualification construct is measured, not as evidence that MBBS status is the uniquely correct measure of clinical skill.

Date: 2026
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