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

Søren Rud Kristensen, Laura Anselmi, Garrett Wallace Brown, Eleonora Fichera, Roxanne Kovacs, Rene Loewenson, Neha Sing, Nicholas Midzi, Fatimah Mustapha, Lee White, Josephine Borghi

Research output: Contribution to journalArticlepeer-review

1 Downloads (Pure)


Purpose: The use of pay for performance as an instrument to incentivize 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. We 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.
Methodology: We identified Cochrane literature reviews of the use of pay for performance 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.
Findings: The quantity and quality of the evidence base has grown over time but can still be improved. Scheme design varies across income settings, and although some design choices may reflect differences in context, we find that incentive designers in both income settings can learn from practices used in the other setting.
Originality: The 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 we are able to draw out key insights between these settings which remain underexplored in the literature.
Original languageEnglish
JournalInternational Journal of Public Sector Management
Publication statusPublished - 31 Aug 2023


  • Pay for performance
  • Quality of health care
  • Quality improvement


Dive into the research topics of 'Pay for performance at a crossroads: Lessons from taking a global perspective'. Together they form a unique fingerprint.

Cite this