This study used a sequential explanatory equal-status mixed-method design to investigate whether Maryland’s child care tiered reimbursement system incentivized child care centers to be rated at least 3 (and receive an incentive payment) on Maryland’s 5-level Quality Rating and Improvement System (QRIS). The first stage of research consisted of multilevel logistic regressions to determine the association between centers’ reliance on child care subsidy payments and whether the center had a rating of 3 or higher. Reliance on subsidy payments was defined as the percentage of licensed slots filled by children receiving a child care subsidy. State administrative data on 1003 centers that received a subsidy payment in January 2018 were combined with demographic data from the U.S. Census. The second stage of research consisted of 14 interviews with center directors to understand how they made decisions about which QRIS rating to attain and how tiered reimbursements factored into their decisions. Results from the quantitative research showed that a greater subsidy density was associated with a greater likelihood of a center being rated 3 and receiving an incentive payment. However, results from the qualitative research showed that few center directors reported that tiered payments factored into their decision on what QRIS rating to reach and no directors were singularly motivated by the incentives. Rather, directors reported being intrinsically motivated to improve QRIS ratings or motivated by technical assistance providers. Additionally, directors who did not attain a rating of 3 experienced capacity challenges. Policy implications are discussed.

这项研究采用顺序说明性的等态混合方法设计，以调查马里兰州的幼儿保育分级报销系统是否激励幼儿保育中心在马里兰州的5级质量评级和改善系统中至少评为3级（并获得奖励金）（ QRIS）。研究的第一阶段包括多级logistic回归，以确定中心对托儿补贴的依赖与中心的评级是否为3或更高之间的关联。依靠补贴付款的定义是接受儿童保育补贴的儿童所占的许可空位百分比。将2018年1月收到补贴的1003个中心的州行政数据与美国人口普查的人口统计数据相结合。研究的第二阶段包括与中心主任进行的14次访谈，以了解他们如何决定要获得哪个QRIS评分以及如何在决策中考虑分级报销。定量研究的结果表明，更大的补贴密度与一个中心被评为3级并获得奖励金的可能性更大有关。但是，定性研究的结果表明，很少有中心主管报告说分层付款是他们决定要达到的QRIS等级的决定，并且没有董事受到激励的唯一动机。相反，董事报告说，其内在动机是为了提高QRIS评分，或者是出于技术支持者的动机。此外，未获得3级评价的董事也遇到了能力挑战。