Article type
Year
Abstract
Background:
The results of Pay-for-performance (P4P) schemes in many countries vary substantially according to the various contextual factors and socio-economic conditions. Previous systematic reviews on P4P did not focus on different health system context. Currently, there is some uncertain rigorous evidence on the direct link of P4P effectiveness to the achievement of universal health coverage (UHC).
Objectives:
To summarize the effects of P4P incentive schemes on the performance of equity of access to healthcare services and clinical effectiveness in UHC systems.
Methods:
Searches were carried out in five electronic databases: The Cochrane Library, MEDLINE, PUBMED, EBSCO, and CINAHL. Only English language studies published between 2000 and 2013 were included in this review with the following inclusion criteria: 1) studies were conducted in the 58 countries that provide UHC; 2) P4P schemes were at supply-sides; 3) outcomes reported quality performance; 4) types of study were randomized controlled trials, controlled before-and-after studies, interrupted time series and observational studies. The studies were extracted using a modified version of the Cochrane Effective Practice and Organisation of Care (EPOC) Group data collection checklist, and the GRADE method was applied to rating quality of evidence.
Results:
The searching resulted in 2264 publications, of which 23 met all the inclusion criteria. The studies came from seven countries: The United Kingdom (14), Taiwan (4), Canada (1), Italy (1), Australia (1), Japan (1) and Argentina (1). The study designs consisted of interrupted-time-series, cohort and cross-sectional studies. Data were summarized into evidence tables.
Conclusions:
It was found that the formal evaluation of P4P performance was very limited. The results were based on the existing qualified studies. P4P scheme seemed to improve the equity of access to healthcare services and the clinical effectiveness in the UHC systems. However, this also depended on the monitoring and evaluation of P4P implementation. Furthermore, the health information technology played a key role in success.
The results of Pay-for-performance (P4P) schemes in many countries vary substantially according to the various contextual factors and socio-economic conditions. Previous systematic reviews on P4P did not focus on different health system context. Currently, there is some uncertain rigorous evidence on the direct link of P4P effectiveness to the achievement of universal health coverage (UHC).
Objectives:
To summarize the effects of P4P incentive schemes on the performance of equity of access to healthcare services and clinical effectiveness in UHC systems.
Methods:
Searches were carried out in five electronic databases: The Cochrane Library, MEDLINE, PUBMED, EBSCO, and CINAHL. Only English language studies published between 2000 and 2013 were included in this review with the following inclusion criteria: 1) studies were conducted in the 58 countries that provide UHC; 2) P4P schemes were at supply-sides; 3) outcomes reported quality performance; 4) types of study were randomized controlled trials, controlled before-and-after studies, interrupted time series and observational studies. The studies were extracted using a modified version of the Cochrane Effective Practice and Organisation of Care (EPOC) Group data collection checklist, and the GRADE method was applied to rating quality of evidence.
Results:
The searching resulted in 2264 publications, of which 23 met all the inclusion criteria. The studies came from seven countries: The United Kingdom (14), Taiwan (4), Canada (1), Italy (1), Australia (1), Japan (1) and Argentina (1). The study designs consisted of interrupted-time-series, cohort and cross-sectional studies. Data were summarized into evidence tables.
Conclusions:
It was found that the formal evaluation of P4P performance was very limited. The results were based on the existing qualified studies. P4P scheme seemed to improve the equity of access to healthcare services and the clinical effectiveness in the UHC systems. However, this also depended on the monitoring and evaluation of P4P implementation. Furthermore, the health information technology played a key role in success.