Fiscal transfers based on inputs or outcomes? Lessons from the Twelfth and Thirteenth Finance Commission in India.

These targets appeared to have been successful in improving health services; each of these indicators showed a positive trend between over 2001‐2005. 11 The effect on services excluded from the ratings, however, is unclear, as there have been allegations of data manipulation and “gaming” to meet the prescribed targets. 12 The move from structure and process indicators in the mid‐2000s towards outcome indicators at the end of the decade was in part due to the recognition that the latter are more effective at capturing improvements in the quality of services, a key goal of any health sector reform.

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