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Cambodia has been at the forefront of performance-based financing (PBF) of health care since 1999. Using survey data on births over a 16 year period, this paper exploits the geographic extension of PBF to estimate its effect on the utilization of maternal and child health services. PBF is estimated to raise the proportion of births occurring in a public health facility by 7.5 percentage points (25%). The impact is much greater if PBF is accompanied by maternity vouchers that cover user fees but there is no significant effect among the poorest women. PBF had no significant impact on the rate of delivery by a skilled birth attendant. A substantial part of the positive effect on the rate of delivery in public facilities arises from switching the location of institutional births from private to public facilities. There is no significant impact of PBF on antenatal care or vaccination rates. Heterogeneous effects across schemes differing in design suggests that maintaining management authority within a health district while giving explicit service targets to facilities is more effective than contracting management to an NGO while denying it full autonomy and leaving financial penalties vague.

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