Pay-for-Performance (P4P) program for quality improvement : a systematic review

Abstract

Background: P4P is being recognized as one of the important incentivising tools in health care reforms to promote quality and efficiency. Numerous studies have tried to produce evidence and experiment its implementation and effect in various health care settings, but definite conclusion cannot be draw due to the lack of, or poor quality of evidence. Purpose: Recognizing the potential advantages and harms, this study aims at reviewing the current literature to evaluate the effect of P4P remuneration for quality improvement. Data Sources and Method: Electronic literature search using EMBASE, MEDLINE, PubMed, internet search, and review of reference lists were done. Studies written in English compatible with the P4P definition, with clearly stated design and outcome measurements were included. PRISMA statement and Cochrane guideline were used as a reference for the appraisal. Results: 503 studies from 2010 to 2015 were found and screened, of which 23 were reviewed. A total of 16 studies were included and evaluated. The majority of studies showed a positive impact on quality with a wide range of outcome improvements, including patient clinical outcomes, patient or provider compliance, patient satisfaction, follow up timeliness, practitioner competency, completeness of data entry. Discussion: Based on the review, P4P in general showed positive impact on quality improvement, with moderate to significant effect, even beyond intended measured outcomes. The exact mechanism of P4P remains unclear. However, the overall evidence was low to very low to establish a relationship between P4P incentives and the improvement. Higher-quality studies with stringent design of controls are required. Meanwhile, funders and government need to take caution about the potential negative impacts of P4P with careful planning before wide implementation. Conflict of interest: None.