Pay for performance at a crossroads: lessons from taking a global perspective

Abstract

PurposeThe use of pay for performance (P4P) as an instrument to incentivise quality improvements in health care is at a crossroads in high-income countries but has remained a commonly used tool in low- and middle-income countries. The authors aimed to take stock of the evidence on effectiveness and design from across income settings to reveal insights for the future design of performance payment across income contexts.Design/methodology/approachThe authors identified Cochrane literature reviews of the use of P4P in health care in any income setting, tracked the development in the quantity and quality of evidence over time, and compared the incentive design features used across high-income countries compared to low- and middle-income countries.FindingsThe quantity and quality of the evidence base have grown over time but can still be improved. Scheme design varies across income settings, and although some design choices may reflect differences in context, the authors find that incentive designers in both income settings can learn from practices used in the other setting.Originality/valueThe research and literature on P4P in high-, low- and middle-income countries largely operate in silos. By taking stock of the evidence on P4P from across income settings, the authors are able to draw out key insights between these settings, which remain underexplored in the literature.

Guest editorial: Payment for performance: comparing policy making, design and implementation in health, social care and education

“…This special issue gathers three types of comparative studies: cross-country comparisons (Zitti et al , 2023; Andersen, 2023), intra country comparisons (Aktas et al , 2023; Srinivasan and Sarin, 2023; Coelho et al , 2023; Dos Anjos et al , 2023) and world-wide meta-analysis from existing literature (Kristensen et al , 2023; Briganti et al, 2023 ). Authors carry out policy process analyses, employing qualitative, mixed methods and review techniques, combined with comparative analytical descriptive accounts.…”

“…Kristensen et al (2023) highlight the heuristic value of generating shared learning by comparing PBF initiatives in different income contexts. Conducting a literature review on the use of PBF in healthcare in high-, middle- and low-income countries, the authors found that the evidence-base produced has grown in quantity and quality, which can help demonstrate the effects of different PBF designs in different contexts.…”

“…World-wide meta-analysis of PBF Two papers develop what might be called world-wide meta-analysis, which seeks to synthesise understandings from a global body of literature on P4P. One is based on recognised published cross-country reviews, bringing a global perspective to key issues in PBF between HIC and LMIC settings (Kristensen et al, 2023), while the other performs a type of meta-synthesis qualitative review (Briganti et al, 2023). Kristensen et al (2023) highlight the heuristic value of generating shared learning by comparing PBF initiatives in different income contexts.…”

“…One is based on recognised published cross-country reviews, bringing a global perspective to key issues in PBF between HIC and LMIC settings (Kristensen et al, 2023), while the other performs a type of meta-synthesis qualitative review (Briganti et al, 2023). Kristensen et al (2023) highlight the heuristic value of generating shared learning by comparing PBF initiatives in different income contexts. Conducting a literature review on the use of PBF in healthcare in high-, middle-and low-income countries, the authors found that the evidence-base produced has grown in quantity and quality, which can help demonstrate the effects of different PBF designs in different contexts.…”