With his recent Presidential Fund for International Studies award, core faculty Grant Miller will travel to China and conduct a supply-side incentive health care initiative.

Miller and Stanford Assistant Professor of Education Jennifer Adams received the grant for their proposal "Paying for Performance in China's Battle against Anemia." In a country where 25 to 50 percent of primary aged children have an iron deficiency, this project will test a new results-oriented approach to battle anemia.

This fall Miller and Adams will measure anemia rates among students in northwest Chinese primary schools, and at the conclusion of the school year, they will again test students’ iron levels. Schools that see a decrease in their students’ anemia rates will receive compensation.

This kind of “pay for performance” approach to health policy remains fairly untested. But, Miller says, it will allow policy makers to ask, “how far can you go in rewarding socially desirable outcomes in making policies work better?”

Unlike most health programs, Miller and Adams won’t set guidelines or restrictions on how to reduce anemia rates. Rather, each school can choose to approach anemia reductions as they see fit—whether through changing nutrition in school lunches, distributing iron supplements, etc.

The measures are clear cut—blood samples drawn from students at the start and end of the school year will test iron levels—and the pupil enrollment numbers already set by education officials. These factors make embellishing anemia rate reductions difficult.

Miller compared it to corporate executives having their salaries tied to their companies’ performance—a numbers based game that demands quantifiable results.

The study also has educational implications. Anemia is associated with heightened listlessness, a weakened immune system and stunted growth. Such symptoms can impair a student’s ability to attend or concentrate in class. Since primary schools are the backdrop for their study, Miller and Adams will also be able to measure the academic impact of reducing anemia.