International Journal of Health Policy and Management

International Journal of Health Policy and Management

Pay for Performance: A Reflection on How a Global Perspective Could Enhance Policy and Research

Document Type : Perspective

Authors
Laura Anselmi 1
Josephine Borghi 2
Garrett Wallace Brown 3
Eleonora Fichera 4
Kara Hanson 2
Artwell Kadungure 5
Roxanne Kovacs 2
Søren Rud Kristensen 6
Neha S. Singh 2
Matt Sutton 1
1 Health, Organisation, Policy and Economics (HOPE), Centre for Primary Care and Health Service Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
2 Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
3 School of Politics and International Studies (POLIS), University of Leeds, Leeds, UK
4 Department of Economics, University of Bath, Bath, UK
5 Training and Research Support Centre (TARSC), Harare, Zimbabwe
6 Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
10.34172/ijhpm.2020.23
Abstract
Pay-for-performance (P4P) is the provision of financial incentives to healthcare providers based on pre-specified performance targets. P4P has been used as a policy tool to improve healthcare provision globally. However, researchers tend to cluster into those working on high or low- and middle-income countries (LMICs), with still limited knowledge exchange, potentially constraining opportunities for learning from across income settings. We reflect here on some commonalities and differences in the design of P4P schemes, research questions, methods and data across income settings. We highlight how a global perspective on knowledge synthesis could lead to innovations and further knowledge advancement.
Keywords
Health Financing
Pay-For-Performance
Comparative Research
  1. Scott A, Sivey P, Ait Ouakrim D, et al. The effect of financial incentives on the quality of health care provided by primary care physicians. Cochrane Database Syst Rev. 2011(9):CD008451. doi:10.1002/14651858.CD008451.pub2
  2. Witter S, Fretheim A, Kessy FL, Lindahl AK. Paying for performance to improve the delivery of health interventions in low- and middle-income countries. Cochrane Database Syst Rev. 2012(2):CD007899. doi:10.1002/14651858.CD007899.pub2
  3. Das A, Gopalan SS, Chandramohan D. Effect of pay for performance to improve quality of maternal and child care in low- and middle-income countries: a systematic review. BMC Public Health. 2016;16:321. doi:10.1186/s12889-016-2982-4
  4. Scott A, Liu M, Yong J. Financial incentives to encourage value-based health care. Med Care Res Rev. 2018;75(1):3-32. doi:10.1177/1077558716676594
  5. Mendelson A, Kondo K, Damberg C, et al. The effects of pay-for-performance programs on health, health care use, and processes of care: a systematic review. Ann Intern Med. 2017;166(5):341-353. doi:10.7326/m16-1881
  6. Eijkenaar F, Emmert M, Scheppach M, Schöffski O. Effects of pay for performance in health care: a systematic review of systematic reviews. Health Policy. 2013;110(2-3):115-130. doi:10.1016/j.healthpol.2013.01.008
  7. Renmans D, Holvoet N, Orach CG, Criel B. Opening the 'black box' of performance-based financing in low- and lower middle-income countries: a review of the literature. Health Policy Plan. 2016;31(9):1297-1309. doi:10.1093/heapol/czw045
  8. Turcotte-Tremblay AM, Spagnolo J, De Allegri M, Ridde V. Does performance-based financing increase value for money in low- and middle- income countries? a systematic review. Health Econ Rev. 2016;6(1):30. doi:10.1186/s13561-016-0103-9
  9. Paul E, Renmans D. Performance-based financing in the heath sector in low- and middle-income countries: Is there anything whereof it may be said, see, this is new? Int J Health Plann Manage. 2018;33(1):51-66. doi:10.1002/hpm.2409
  10. Ogundeji YK, Bland JM, Sheldon TA. The effectiveness of payment for performance in health care: a meta-analysis and exploration of variation in outcomes. Health Policy. 2016;120(10):1141-1150. doi:10.1016/j.healthpol.2016.09.002
  11. Chikovani I, Diaconu K, Duric P, et al. Addressing challenges in tuberculosis adherence via performance-based payments for integrated case management: protocol for a cluster randomized controlled trial in Georgia. Trials. 2019;20(1):536. doi:10.1186/s13063-019-3621-z
  12. NHS England. Report of the Review of the Quality and Outcomes Framework in England. London: NHS England; 2018.
  13. Tafesse W, Manthalu G, Chalkley M. The Effect of Government Contracting with Faith-based Health Care Providers in Malawi. York, UK: Centre for Health Economics, University of York; 2019.
  14. Meessen B, Soucat A, Sekabaraga C. Performance-based financing: just a donor fad or a catalyst towards comprehensive health-care reform? Bull World Health Organ. 2011;89(2):153-156. doi:10.2471/blt.10.077339
  15. Anselmi L, Binyaruka P, Borghi J. Understanding causal pathways within health systems policy evaluation through mediation analysis: an application to payment for performance (P4P) in Tanzania. Implement Sci. 2017;12(1):10. doi:10.1186/s13012-016-0540-1
  16. Ngo DK, Sherry TB, Bauhoff S. Health system changes under pay-for-performance: the effects of Rwanda's national programme on facility inputs. Health Policy Plan. 2017;32(1):11-20. doi:10.1093/heapol/czw091
  17. Nimpagaritse M, Korachais C, Meessen B. Effects in spite of tough constraints - A theory of change based investigation of contextual and implementation factors affecting the results of a performance based financing scheme extended to malnutrition in Burundi. PLoS One. 2020;15(1):e0226376. doi:10.1371/journal.pone.0226376
  18. Grigoroglou C, Munford L, Webb RT, et al. Association between a national primary care pay-for-performance scheme and suicide rates in England: spatial cohort study. Br J Psychiatry. 2018;213(4):600-608. doi:10.1192/bjp.2018.143
  19. Huillery E, Seban J. Money for Nothing? The Effect of Financial Incentives on Efforts and Performances in the Health Sector. https://www.povertyactionlab.org/sites/default/files/publications/496_Money-for-Nothing_Huillery_DRC_May2017.pdf.  Published May 26, 2017.
  20. Kristensen SR, Meacock R, Sutton M. Methodology for Modelling Changes in Health Services Delivery and Policy - Vignette prepared for the MRC-NIHR Methodology Research Programme Advisory Group. https://pdfs.semanticscholar.org/5143/ba743ca19b45116e193e12670bcac8794042.pdf. Published February 16, 2015.
  21. Minchin M, Roland M, Richardson J, Rowark S, Guthrie B. Quality of care in the United Kingdom after removal of financial incentives. N Engl J Med. 2018;379(10):948-957. doi:10.1056/NEJMsa1801495
  22. Bodson O, Barro A, Turcotte-Tremblay AM, Zanté N, Somé PA, Ridde V. A study on the implementation fidelity of the performance-based financing policy in Burkina Faso after 12 months. Arch Public Health. 2018;76:4. doi:10.1186/s13690-017-0250-4
  23. Antony M, Bertone MP, Barthes O. Exploring implementation practices in results-based financing: the case of the verification in Benin. BMC Health Serv Res. 2017;17(1):204. doi:10.1186/s12913-017-2148-9
  24. De Allegri M, Bertone MP, McMahon S, Mounpe Chare I, Robyn PJ. Unraveling PBF effects beyond impact evaluation: results from a qualitative study in Cameroon. BMJ Glob Health. 2018;3(2):e000693. doi:10.1136/bmjgh-2017-000693
  25. Witter S, Chirwa Y, Chandiwana P, Munyati S, Pepukai M, Bertone MP. The political economy of results-based financing: the experience of the health system in Zimbabwe. Glob Health Res Policy. 2019;4:20. doi:10.1186/s41256-019-0111-5
  26. World Health Organization (WHO). Strategic Purchasing for Universal Health Coverage: Unlocking the Potential - Global meeting summary and key messages. Geneva, Switzerland: WHO; 2017.
  27. Witter S, Bertone MP, Namakula J, et al. (How) does RBF strengthen strategic purchasing of health care? Comparing the experience of Uganda, Zimbabwe and the Democratic Republic of the Congo. Glob Health Res Policy. 2019;4:3. doi:10.1186/s41256-019-0094-2
  28. Binyaruka P, Robberstad B, Torsvik G, Borghi J. Does payment for performance increase performance inequalities across health providers? a case study of Tanzania. Health Policy Plan. 2018;33(9):1026-1036. doi:10.1093/heapol/czy084
  29. Gaughan J, Gutacker N, Grasic K, Kreif N, Siciliani L, Street A. Paying for efficiency: incentivising same-day discharges in the English NHS. J Health Econ. 2019;68:102226. doi:10.1016/j.jhealeco.2019.102226
  30. Bertone MP, Lurton G, Mutombo PB. Investigating the remuneration of health workers in the DR Congo: implications for the health workforce and the health system in a fragile setting. Health Policy Plan. 2016;31(9):1143-1151. doi:10.1093/heapol/czv131
  31. Maini R, Mounier-Jack S, Borghi J. Performance-based financing versus improving salary payments to workers: insights from the Democratic Republic of Congo. BMJ Glob Health. 2018;3(5):e000958. doi:10.1136/bmjgh-2018-000958
  32. Maini R, Lohmann J, Hotchkiss DR, Mounier-Jack S, Borghi J. What happens when donors pull out? examining differences in motivation between health workers who recently had performance-based financing (PBF) withdrawn with workers who never received PBF in the Democratic Republic of Congo. Int J Health Policy Manag. 2019;8(11):646-661. doi:10.15171/ijhpm.2019.55
  33. Kristensen SR, Meacock R, Turner AJ, et al. Long-term effect of hospital pay for performance on mortality in England. N Engl J Med. 2014;371(6):540-548. doi:10.1056/NEJMoa1400962
  34. Ryan AM, Krinsky S, Kontopantelis E, Doran T. Long-term evidence for the effect of pay-for-performance in primary care on mortality in the UK: a population study. Lancet. 2016;388(10041):268-274. doi:10.1016/s0140-6736(16)00276-2
  35. Jha AK, Joynt KE, Orav EJ, Epstein AM. The long-term effect of premier pay for performance on patient outcomes. N Engl J Med. 2012;366(17):1606-1615. doi:10.1056/NEJMsa1112351
  36. Borghi J, Little R, Binyaruka P, Patouillard E, Kuwawenaruwa A. In Tanzania, the many costs of pay-for-performance leave open to debate whether the strategy is cost-effective. Health Aff (Millwood). 2015;34(3):406-414. doi:10.1377/hlthaff.2014.0608
  37. Paul E, Lamine Drame M, Kashala JP, et al. Performance-based financing to strengthen the health system in Benin: challenging the mainstream approach. Int J Health Policy Manag. 2018;7(1):35-47. doi:10.15171/ijhpm.2017.42
  38. Soucat A, Dale E, Mathauer I, Kutzin J. Pay-for-performance debate: not seeing the forest for the trees. Health Syst Reform. 2017;3(2):74-79. doi:10.1080/23288604.2017.1302902
  39. Mayumana I, Borghi J, Anselmi L, Mamdani M, Lange S. Effects of Payment for Performance on accountability mechanisms: evidence from Pwani, Tanzania. Soc Sci Med. 2017;179:61-73. doi:10.1016/j.socscimed.2017.02.022
  40. Meacock R, Kristensen SR, Sutton M. The cost-effectiveness of using financial incentives to improve provider quality: a framework and application. Health Econ. 2014;23(1):1-13. doi:10.1002/hec.2978
  41. Pandya A, Doran T, Zhu J, Walker S, Arntson E, Ryan AM. Modelling the cost-effectiveness of pay-for-performance in primary care in the UK. BMC Med. 2018;16(1):135. doi:10.1186/s12916-018-1126-3
  42. Hauck K, Morton A, Chalkidou K, et al. How can we evaluate the cost-effectiveness of health system strengthening? a typology and illustrations. Soc Sci Med. 2019;220:141-149. doi:10.1016/j.socscimed.2018.10.030
  43. Alshamsan R, Majeed A, Ashworth M, Car J, Millett C. Impact of pay for performance on inequalities in health care: systematic review. J Health Serv Res Policy. 2010;15(3):178-184. doi:10.1258/jhsrp.2010.009113
  44. Boeckxstaens P, Smedt DD, Maeseneer JD, Annemans L, Willems S. The equity dimension in evaluations of the quality and outcomes framework: a systematic review. BMC Health Serv Res. 2011;11:209. doi:10.1186/1472-6963-11-209
  45. Doran T, Fullwood C, Kontopantelis E, Reeves D. Effect of financial incentives on inequalities in the delivery of primary clinical care in England: analysis of clinical activity indicators for the quality and outcomes framework. Lancet. 2008;372(9640):728-736. doi:10.1016/s0140-6736(08)61123-x
  46. Binyaruka P, Robberstad B, Torsvik G, Borghi J. Who benefits from increased service utilisation? examining the distributional effects of payment for performance in Tanzania. Int J Equity Health. 2018;17(1):14. doi:10.1186/s12939-018-0728-x
  47. Ridde V, Gautier L, Turcotte-Tremblay AM, Sieleunou I, Paul E. Performance-based financing in Africa: time to test measures for equity. Int J Health Serv. 2018;48(3):549-561. doi:10.1177/0020731418779508
  48. Roland M, Guthrie B. Quality and Outcomes Framework: what have we learnt? BMJ. 2016;354:i4060. doi:10.1136/bmj.i4060
  49. Horton P, Brown GW. Integrating evidence, politics and society: a methodology for the science–policy interface. Palgrave Commun. 2018;4(1):42. doi:10.1057/s41599-018-0099-3
  50. Sparkes SP, Kutzin J, Soucat A, Bump JB, Reich MR. Introduction to special issue on political economy of health financing reform. Health Syst Reform. 2019;5(3):179-182. doi:10.1080/23288604.2019.1649915
International Journal of Health Policy and Management
Volume 9, Issue 9
September 2020
Pages 365-369

  • Received Date 15 November 2019
  • Revised Date 07 February 2020
  • Accepted Date 15 February 2020
  • First Published Date 01 September 2020
  • Published Date 01 September 2020