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Eur J Health Econ (2012) 13:755767 DOI 10.1007/s10198-011-0329-8
ORIGINAL PAPER
Economic evaluation of pay-for-performance in health care: a systematic review
Martin Emmert Frank Eijkenaar Heike Kemter
Adelheid Susanne Esslinger Oliver Schffski
Received: 17 August 2010 / Accepted: 25 May 2011 / Published online: 10 June 2011 Springer-Verlag 2011
AbstractBackground Pay-for-performance (P4P) intents to stimulate both more effective and more efcient health care delivery. To date, evidence on whether P4P itself is an efcient method has not been systematically analyzed. Objective To identify and analyze the existing literature regarding economic evaluation of P4P.
Data sources English, German, Spanish, and Turkish language literature were searched in the following databases: Business Source Complete, the Cochrane Library, Econlit, ISI web of knowledge, Medline (via PubMed), and PsycInfo (January 2000April 2010).
Study selection Articles published in peer-reviewed journals and describing economic evaluations of P4P initiatives. Full economic evaluations, considering costs and consequences of the P4P intervention simultaneously, were the prime focus. Additionally, comparative partial evaluations were included if costs were described and the study
allows for an assessment of consequences. Both experimental and observational studies were considered. Results In total, nine studies could be identied. Three studies could be regarded as full economic evaluations, and six studies were classied as partial economic evaluations. Based on the full economic evaluations, P4P efciency could not be demonstrated. Partial economic evaluations showed mixed results, but several aws limit their significance. Ranges of costs and consequences were typically narrow, and programs differed considerably in design. Methodological quality assessment showed scores between 32% and 65%.
Conclusion The results show that evidence on the efciency of P4P is scarce and inconclusive. P4P efciency could not be demonstrated. The small number and variability of included studies limit the strength of our conclusions. More research addressing P4P efciency is needed.
Keywords Pay-for-performance P4P Economic
evaluation Efciency ROI Cost-effectiveness
JEL Classication I11 I12 J33
Introduction
Background
Many current health care systems can be characterized by ineffectiveness and inefciency [15]. One reason for that can be found in the payment system of physicians; incentives that foster efcient delivery of high-quality care are often lacking [610]. Another reason is a lack of transparency about the quality and efciency of care [11]. A
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