This section of the literature review contains studies which focus on payment by results interventions in the health sector.

Pay for performance initiatives, as PbR is often known in the health sector, have been running for many years in different countries and produced mixed results. Confusingly, the NHS Payment by Results initiative is not what most people think of as PbR, rather than focusing on outcomes, it is more about setting a standard tariff for different health interventions.

For each study, I provide the full reference, a link to the document if available freely online and a one sentence summary.

Studies are presented in order of publication; most recent first.

Studies which I regard as of high quality or of particular interest are highlighted in bold.

You can jump to the seven other sections of research here:


Mental Health Australia (2015) Discussion paper: options for commissioning and funding of mental health services. Deakin: Mental Health Australia

Helpful speculation around how PbR does and does not fit with commissioning of mental health services, recommends piloting a mixed model.

Lagarde, M.; Wright, M.; Nossiter, J. & Mays, N. (2013) Challenges of payment-for-performance in health care and other public services – design, implementation and evaluation. London: Policy Research Unit in Policy Innovation Research.

Good review of broader P4P (not all PbR) which concludes that “The jury is still out on whether the benefits of P4P schemes in public services exceed their costs.”

Flodgren, G. et al. (2011) An overview of reviews evaluating the effectiveness of financial incentives and changing healthcare professional behaviours and patient outcomes. Cochrane database of systematic reviews 2011, Issue 7. Art. No.: CD 009255

Concludes that financial incentives may be effective in changing healthcare professional practice but not patient outcomes.

Alshamsan, R. et al. (2010) Impact of pay for performance on inequalities in health care: systematic review. Journal Health Service Research Policy. 2010 Jul;15(3):178-84.

Only slight impact on inequalities in this study of pay for performance schemes.

Van Herck, P et al. (2010) Systematic review: Effects, design choices, and context of pay-for-performance in healthcare. BMC Health Services Research 10:247

Systematic review of 128 evaluation studies on pay for performance on clinical effectiveness and equity of care found a very wide range of possible effects for specific targets, from absent or negligible to strongly beneficial.

Mullen, K.; Frank, R. and Rosental, M. (2009) Can you get what you pay for? Pay for performance on the quality of healthcare providers. Cambridge, MA: National Bureau of Economic Research, working paper 14886

Large scale quantitative analysis of impact of P4P on healthcare found no consistent improvements, nor disruption of care.

Karve, A. et al. (2007) Potential unintended financial consequences of pay-four-performance on the quality of care for minority patients. American Heart Journal March 2008.

American study which found that racial discrimination was compounded by a PbR approach which penalised worst performing hospitals.

Petersen, L. et al. (2006) does pay for performance improve the quality of healthcare? Annals of Internal Medicine Volume 145 Number 4 pp 265 – 272