Payment methods

Payment rate determined

Payment made

Payment related to

Prospectively

Retrospectively

Prospectively

Retrospectively

Inputs

Outputs

Line‐item budgets

√

√

√

Global budgets

√

√

√

√

Capitation

√

√

√

Fee‐for‐service

‐Unconstrained

√

√

√

‐Fixed

√

√

√

Pay for performance

√

√

√

Reimbursement type

Performance

Services/Case

Quantity

Quality

Cost/Unit

Risk selection

Line‐item budgets

‐

‐‐

‐

+

0

Global budgets

‐‐

‐

‐

‐‐

0

Capitation

‐‐

‐‐

‐

‐‐

++

Fee‐for‐service

‐Unconstrained

++

+

‐‐

‐

0

‐Fixed

++

+

‐‐

‐‐

+

Case‐based

‐‐

++

++

‐‐

+

Pay for performance

+

++

++

‐‐

+

Explanatory factors

How we will categorise the factor

Hypothesised direction of the interaction

Basis for the hypothesis

Larger fees (per service)

Relative increase in fees (continuous)

Larger (positive) effects with larger relative increases

The larger the incentive, the larger the effect

Duration of follow‐up

When outcomes are measured relative to when the change was made (continuous)

Larger (positive) effects with shorter follow‐up

Other changes and adjustments over time might reduce the initial incentive.

Ownership

For‐profit vs not‐for‐profit ownership

Larger (positive) effects with for‐profit ownership

For‐profit facilities might be more motivated to increase income and therefore more sensitive to changes in incentives.

Multiple providers

Choice of providers available to patients vs little or no choice of providers

Larger (negative) effects with little or no choice

Need to attract and retain patients might provide counteractive incentives to offer more services.

Monitoring

Monitoring vs no monitoring of the delivery of services

Larger (negative) effects without monitoring

Monitoring might provide counteractive incentives to offer more services.

Study

Performance measures

Performance target

Size of incentive

Frequency of monitoring

Frequency of payment

Individual payment

Resourcing (if with more funds)

Alshamsan 2012

Lee 2011

Serumaga 2011

McLintock 2014

Both provision and outcome measures: 76 clinical quality indicators and 70 indicators relating to organisation of care and patient experience. Of the clinical indicators, 10 relate to maintaining disease registers, 56 to processes of care (such as measuring disease parameters and giving treatments), and 10 to intermediate outcomes (such as controlling blood pressure).

Threshold payment: Practices are awarded points based on the proportion of patients for whom targets are achieved, between a lower achievement threshold of 40% for most indicators (i.e. practices must achieve the targets for over 40% of patients to receive any points) and an upper threshold that varies according to the indicator. Each point earned the practice the certain level of money, adjusted for patient population size and disease prevalence. A maximum of 1000 points was available.

The highest level of performance payment is 25% of total income.

Annual

Annual

Allocated to individual based on individual performance

Yes

An 2008

Provision outcome measures: referral of smokers to consultation

Threshold payment combined with payment for each instance: Clinics that referred 50 smokers would receive a USD 5000 performance bonus. Clinics would also receive $25 for each referral beyond the initial 50.

Not clear, but mentioned "This incentive amount was arrived at after consultation with the management team and represents an amount that was judged as likely to be meaningful to most clinics ..."

10 months

10 months

Into clinics' operation fund, no payment to individual physicians and administrators

Yes

Bardach 2013

Both provision and outcome measures: 4 quality goals, including aspirin prescription, blood pressure control, cholesterol control, and smoking cessation intervention provision

Payment for each instance of performance measure unit: An incentive was paid for every instance of a patient meeting the quality goal (e.g. 1 blood pressure control USD 20). A higher payment was paid for patients with certain comorbidities or, as proxies for socioeconomic status, had Medicaid insurance or were uninsured.

Approximately 5% of an average physician's annual salary

Quarterly

Annual

Allocated to individual based on individual performance

Yes

Basinga 2011

Process measures: The 14 key maternal and child healthcare output indicators. Some of these output indicators are reasons for a visit, such as prenatal care or delivery, whereas others are services provided during a visit, such as tetanus vaccination during prenatal care.

Payment for each instance of performance measure unit: Basis for payment is calculated based on the number of 14 kinds of services provided; the final payment level is adjusted based on quality index.

Facility funding increased by 22%

Quarterly

Quarterly

77% of P4P¹ funds to allocate to individual personnel, amounting to 35% increase in salary

No, control group funding also increased by the same level.

Canavan 2008

Process measures: outpatient utilisation rate, delivery rate, VCT² clients

Threshold payment: 50% of support paid upfront for the year; 50% paid retrospectively if all the targets are met (outpatient utilisation rate 0.6, delivery rate 20/1000, VCT² clients 20/1000).

8% of facility income

Semi‐annual

Semi‐annual

50% maximum bonus allocated to individual

Yes

Chien 2012

Both provision and outcome measures: diabetes patient completing all the missing care processes, and whether glycated haemoglobin and low‐density lipoprotein levels were lowered or at goal levels

Payment for each instance of performance measure unit: Certain amount of money for each patient paid if this patient met the performance target, e.g. USD 15 for 1 glycated haemoglobin test, USD 35 for glycated haemoglobin < 7%.

Not clear, but mentioned that "then incentive amount ... may not have been strong enough"

Annual

Annual

Not clear

Yes

Engineer 2016

Provision outcome measures: volume of 9 primary health services provided, combined with service provision quality indicators

Payment for each instance of performance measure unit: Certain amount of bonus per unit per quarter, e.g. USD 1.30 to USD 2.67 for first antenatal care visit; final payment was also adjusted by quality indicators.

The bonus amounts paid
were about 6% to 11% above health workers' base salary, and increased to about 14% to 28% depending on the health worker's cadre.

Quarterly

Quarterly

All allocated to individual, but the allocation method was determined by health facility managers, including giving individual bonuses proportional to the health worker's salary, giving them in equal amounts to all staff, or giving them based on their determination of an individual's contribution to the performance indicators.

Yes

Hillman 1998

Provision outcome measures: compliance with a quality assurance policy, i.e. is referral of clinically indicated for Pap test, colorectal screening, or mammography

Threshold payment: 3 intervention sites with highest compliance scores received full bonus (20% of capitation); 3 with the next highest scores and the 3 improving most from previous audit both received partial bonus (10% of capitation).

10% to 20% of capitation for all female members 50 years of age and older

Semi‐annual

Semi‐annual

Not clear, 38.5% of sites were solo group.

Yes

Hillman 1999

Provision outcome measures: compliance with provision of defined services for children, including immunisation, other preventive services

Threshold payment: 3 intervention sites with highest compliance scores received full bonus (20% of capitation); 3 with the next highest scores and the 3 improving most from previous audit both received partial bonus (10% of capitation).

10% to 20% of capitation for all paediatric members up to 7 years

Semi‐annual

Semi‐annual

Not clear, 42.1% of sites were solo group.

Yes

Petersen 2013

Combined provision and outcome measures: blood pressure thresholds or appropriately responding to uncontrolled blood pressure, prescribing guideline‐recommended antihypertensive medications

Payment for each instance: a maximum prerecord reward of USD 18.20, USD 9.10 for each successful measure

Mean level was 1.6% of a physician's salary.

4 months

4 months

Equally allocated to individual physician, non‐physician in team

Yes

Roski 2003

Provision outcome measures: Tobacco status clearly identified at each visit and documented in their medical records for their last visit; smokers should have provision of advice to quit smoking documented in their medical record.

Threshold payment: Performance targets were set at approximately 15 percentage points above the average performance for these clinic practices as assessed by the medical group 2 years prior to the effort described here. Incentive amounts were based on the number of providers per clinic. Specifically, clinics with 1 to 7 providers could receive a USD 5000 award, and clinics with 8 or more providers were eligible for a USD 10,000 bonus. Clinics that reached or exceeded only 1 of the 2 performance goals were eligible for half the amount.

Not clear, just discussed "it is not clear whether significantly higher incentive payments would have been able to focus clinic sites'

attention more strongly on ..."

Semi‐annual

Annual

Not clear, just mentioned "Clinics were provided with suggestions on how to spend earned incentive payments (i.e., travel and registration for educational courses). Ultimately, clinics decided how to allocate incentive payments."

Yes

Soeters 2008

Bonfrer 2014a

Rudasingwa 2015

Provision measures: health provision actions and quality composite index

Payment for each instance: Fixed amount paid per targeted action; multiplied by quality bonus ranging from 1 to 1.25 based on quarterly reviews of quality.

Studies published at different times reported different proportions:

58% of facility total revenue in 2009;

in 2014, this part accounted for 40% of total health facility budget;

in 2010, 20% of total health facility revenue.

Quarterly

Quarterly

Allocated to individual based on individual performance, using a systematic approach called "indices".

Yes

Soeters 2011

Provision measures: health provision actions and quality composite index with 154 indicators

Payment for each instance: Fixed amount paid per targeted action; top‐up of 15% available, based on quarterly reviews of quality. Also 15% additional payment for remote facilities.

Not clear, but should be the major component of funding for the health centres

Quarterly

Quarterly

Just mentioned facilities having discretion to pay staff.

Yes

Yip 2014

Provision measures: antibiotic prescription rates and patient satisfaction

Threshold payment: 70% of the budget allocated to health facilities firstly, withholding the balance until after performance assessments at the middle and end of the year; after each assessment, the performance scores were compared between each health facility to the average score in the county; each centre that scored above the average received more than the 30% of the budget that had been withheld, in proportion to how much above the county average its score was. Each centre that scored below the average received less than the 30%, in proportion to how much lower than average its score was.

30% of capitation budget

Semi‐annual

Semi‐annual

No allocation to individual

No

Study

Primary outcomes

Secondary outcomes

Unintended or adverse effects

Length of observation

Provision outcomes

Patient outcomes

Costs

Bardach 2013

Proportion of patients 18 years or older with IVD¹ or 40 years or older with DM² taking aspirin or another antithrombotic therapy (including cilostazol, clopidogrel bisulfate, warfarin sodium, dipyridamole);

Proportion of patients 18 years or older identified as current smokers who received certain smoking cessation services (cessation counselling, referral for counselling, or prescription or increased dose of a cessation aid)

Proportion of patients aged 18 to 75 years with hypertension getting blood pressure control (with blood pressure lower than 140/90 mmHg (if without DM²) or lower than 130/80 mmHg (if with DM²)) (Health);

Proportion of male patients 35 years or older and female patients 45 years or older without IVD¹ or DM² who have cholesterol control (total cholesterol lower than 240 mg/dL or low‐density lipoprotein lower than 160 mg/dL measured in the past 5 years) (Health)

—

—

—

12 months

Petersen 2013

Proportion of physicians' patients getting the guideline‐recommended antihypertensive medications

Proportion of physicians' patients with blood pressure control or appropriate response to uncontrolled blood pressure (Health)

—

—

Performance of physician groups during the final intervention period to the post‐washout performance period

24 months

Chien 2012

—

Probability of diabetes patients getting glycated haemoglobin testing (Utilisation);

Probability of diabetes patients getting lipid testing (Utilisation);

Probability of diabetes patients getting dilated eye exam (Utilisation)

—

—

—

12 months

Basinga 2011

Probablity of respondents getting tetanus vaccine during prenatal visit

Probability of respondents having any prenatal care (Utilisation);

Probability of respondents having 4 or more prenatal care visits (Utilisation);

Probability of respondents having institutional delivery (Utilisation);

Probability of children younger than 23 months preventive visit in previous 4 weeks (Utilisation);

Probability of children aged 24 to 59 months preventive visit in previous 4 weeks (Utilisation);

Probability of children aged 12 to 23 months being fully immunised (Utilisation)

—

—

—

23 months

Roski 2003

Percentage of tobacco users identified at last visit;

Percentage of smokers who received advice to quit;

Percentage of smokers who were offered assistance to quit at last visit

Percentage of respondents reporting using any aids for smoking cessation (Utilisation);

Percentage of respondents reporting using any medication for quitting (Utilisation);

Percentage of respondents reporting using any counselling services (Utilisation);

Percentage of smoker respondents 7‐day sustained abstinence from smoking (Health);

Percentage of respondents being current smokers (7‐day point prevalence);

Percentage of respondents reporting intention to quit within 30 days (Health)

—

—

—

12 months for provision outcomes;

18 months for patient outcomes

Serumaga 2011

Proportion of patients receiving 0, 1, 2, and 3 or more classes of antihypertensive drugs as a proportion of all study patients

Proportion of patients with blood pressure measured each month (Utilisation);

Proportion of patients with controlled blood pressure (blood pressure less than 150/90 mmHg) (Health);

Percentage of patients with hypertension‐related adverse outcomes (myocardial infarction, stroke, renal failure, heart failure) or on all‐cause mortality (Health)

—

—

—

12 months;

24 months;

36 months

An 2008

Rate of referral of smokers to quit line

Rate of smokers enrolled into quit line (Utilisation)

—

The marginal cost per additional quit line enrollee

—

10 months

Hillman 1999

Compliance scores³ of providers for immunisation;

Compliance scores of providers for other indicators;

Overall compliance scores of providers

—

—

—

—

6 months;

12 months;

18 months

Hillman 1998

Compliance scores for Pap test;

Compliance scores for colorectal screening;

Compliance scores for mammography;

Compliance scores for breast exam;

Total compliance scores

—

—

—

—

6 months;

12 months;

18 months

Alshamsan 2012

—

Glycated haemoglobin level for diabetes patients;

Total cholesterol level for diabetes patients (Health);

Systolic blood pressure for diabetes patients (Health);

Diastolic blood pressure for diabetes patients (Health)

—

—

Ethnic disparities in all outcomes

12 months;

24 months;

36 months

Lee 2011

—

Total cholesterol level for CHD⁴ patients (Health);

Total cholesterol level for stroke patients (Health);

Systolic blood pressure for CHD⁴ patients (Health);

Systolic blood pressure for stroke patients (Health);

Systolic blood pressure for hypertension patients (Health);

Diastolic blood pressure for CHD⁴ patients (Health);

Diastolic blood pressure for stroke patients (Health);

Diastolic blood pressure for hypertension patients (Health)

—

—

Ethnic disparities in all outcomes

12 months;

24 months;

36 months

Yip 2014

Percentage of visits with antibiotic prescription in Township Health Centre;

Percentage of visits with antibiotic prescription in Village Posts

—

—

Patient satisfaction score in Township Health Centre;

Patient satisfaction score in Village Posts;

Total expenditure per visit;

Total drug expenditure visit

Patient volume

—

Catalano 2000

Number of people younger than 18 receiving outpatient services

Number of people younger than 18 receiving inpatient services;

Number of people younger than 5 in treatment;

Number of disruptive children in treatment;

Number of people younger than 18 treated in emergency

Total outpatient costs;

Total costs of treating people younger than 18;

Total inpatient costs

—

—

12 months

18 months

Catalano 2005

—

Number of emergency visits by adults who had a primary mental or substance use disorder

—

—

—

12 months

Engineer 2016

—

Percentage of current use of modern family planning methods;
Percentage of at least 1 antenatal checkup from a skilled provider;
Percentage of skilled birth attendant present at latest delivery;
Percentage of postnatal checkup within 42 days of delivery by
a skilled provider;
Percentage of children who received pentavalent 3 vaccination;

Concentration index for institutional deliveries;
Concentration index for children's utilisation of outpatient services

—

20 indicators covering 5 domains of quality of care: Client and community perspectives, including an index of overall client satisfaction and perceived quality of care; Human resources perspectives, including a health worker satisfaction index and health worker motivation index; Physical capacity of health facility inputs (drugs, equipment, infrastructure); Quality of service provision, measuring 4 processes of care; and Management systems

—

23 to 25 months

McLintock 2014

Percentage of patients on the diabetes register or CHD⁴ register, or both, for whom case finding, diagnosis, and prescription for depression has been undertaken

—

—

—

Percentage of patients with non‐target long‐term physical conditions for whom case finding for depression, diagnosis, and prescription has been undertaken

60 months

Study

Outcome measures

Control/baseline level

Risk ratio

Confidence intervals

1.USA Bardach 2013, randomised trial

Proportion of patients with ischaemic vascular disease or diabetes mellitus getting aspirin therapy prescription

59.7%

1.10

1.04, 1.16

Proportion of patients getting smoking cessation intervention

18.9%

1.23

1.03, 1.46

Synthesised effects inside the study (fixed‐effect model)

—

1.11

1.05, 1.17

2. USA Petersen 2013, randomised trial

Percentage of patients prescribed guideline‐recommended medications

63.0%

1.01

0.92, 1.12

3. Rwanda Basinga 2011, CBA

Proportion of respondents getting tetanus vaccine during prenatal visit

67.0%

1.08

0.997, 1.15

Synthesised effect across the above 3 studies (random‐effects model)

—

1.08

1.03, 1.14

4. USA Roski 2003, randomised trial

Percentage of patients identified as tobacco users at last visit

40.5%

1.20

—

Percentage of smokers who received advice to quit

35.4%

1.17

—

Percentage of smokers who were offered assistance to quit at last visit

19.7%

0.72

—

Synthesised effects inside the study (median)

—

1.17

—

Synthesised effect across the above 4 studies (median)

—

1.095

—

Study

Outcome measures

Control/baseline level

Absolute change

Relative change

1. USA An 2008, randomised trial

Rate of referral of smokers to quit line (not adjusted by baseline, not used for analysis)

4.2%

7.2%

+171%

2. USA Hillman 1999, randomised trial

Compliance scores for immunisation

60.2%

4.8%

+7.97%

Compliance scores for other indicators

55.2%

3.2%

+5.80%

Overall compliance scores

53.7%

2.8%

+5.21%

Synthesised effects inside the study (median)

—

3.2%

5.80%

3. USA Hillman 1998, randomised trial

Compliance scores for Pap test

25.4%

‐5.2%

‐20.47%

Compliance scores for colorectal screening

14.9%

3.3%

+22.15%

Compliance scores for mammography

40.9%

‐5.1%

‐12.47%

Compliance scores for breast exam

23.0%

‐0.2%

‐0.87%

Total compliance scores

27.1%

‐2.3%

‐8.49%

Synthesised effects inside the study (median)

—

‐2.3%

‐8.49%

Synthesised effect across the above 4 studies (median)

—

—

‐1.345%

Comparison 1: P4P plus some existing payment method vs existing payment method

Study

Immediate change in level

Change in trend

Other effects results reported by authors

Estimate

Confidence interval

Estimate

Confidence interval

Serumaga 2011, ITS

Proportion of patients receiving 1 drug (%) (provision outcome)

0.07

‐0.83, 0.98

0.03

‐0.01 to 0.07

‐

Proportion of patients receiving 2 drugs (%) (provision outcome)

0.03

‐0.19, 0.26

‐0.01

‐0.01 to 0.02

‐

Proportion of patients receiving 3 or more drugs (%) (provision outcome)

0.11

‐0.26, 0.47

0.02

‐0.15 to 0.18

‐

Percentage of patients with blood pressure measured each month (%) (patient outcome, utilisation)

0.85

‐3.04, 4.74

‐0.01

‐0.24 to 0.21

‐

Proportion of patients with controlled blood pressure (%) (patient outcome, health)

‐1.19

‐2.06, 1.09

‐0.01

‐0.06 to 0.03

‐

Percentage of patients with hypertension‐related adverse outcomes (myocardial infarction, stroke, renal failure, heart failure) or on all‐cause mortality (%) (patient outcome, health)

0.07

‐0.13, 0.28

0.05

‐0.02 to 0.07

‐

Alshamsan 2012, RM

Systolic blood pressure level (patient outcome, health)

‐1.95

‐2.87, ‐1.02

‐1.04

‐1.42 to ‐0.64

‐

Diastolic blood pressure level (patient outcome, health)

‐0.51

‐1.05, 0.01

0.19

‐0.03 to 0.41

‐

Total cholesterol level (patient outcome, health)

‐0.12

‐0.18, ‐0.06

0.03

0.01 to 0.05

‐

Glycated haemoglobin level (patient outcome, health)

0.04

‐0.04, 0.12

0.19

0.15 to 0.22

‐

Lee 2011, RM

Systolic blood pressure level for CHD patients (patient outcome, health)

‐0.81

‐2.01, 0.49

‐0.53

‐1.09 to 0.02

‐

Diastolic blood pressure level for CHD patients (patient outcome, health)

‐0.32

‐1.06, 0.42

0.32

‐0.00 to 0.64

‐

Total cholesterol level for CHD patients (patient outcome, health)

‐0.01

‐0.08, 0.06

0.02

‐0.01 to 0.05

‐

Systolic blood pressure level for stroke patients (patient outcome, health)

‐1.92

‐3.89, 0.05

‐0.79

‐1.64 to 0.06

‐

Diastolic blood pressure level for stroke patients (patient outcome, health)

‐0.38

‐1.50, 0.74

0.26

‐0.22 to 0.74

‐

Total cholesterol level for stroke patients (patient outcome, health)

‐0.11

‐0.23, 0.02

‐0.01

‐0.05 to 0.07

‐

Systolic blood pressure level for hypertension patients (patient outcome, health)

‐1.18

‐1.76, ‐0.61

‐0.83

‐1.08 to ‐0.58

‐

Diastolic blood pressure level for hypertension patients (patient outcome, health)

‐0.77

‐1.10, ‐0.43

0.03

‐0.11 to 0.18

‐

McLintock 2014

Rate of coded case finding for depression in patients with diabetes and CHD (provision outcome)

‐

‐

‐

‐

Increase from 0.07/1000 to 7.45/1000 per month (OR 99.76, 95% CI 83.15 to 119.68)

Rate of new depression‐related diagnoses in patients with diabetes and CHD (provision outcome)

‐

‐

‐

‐

Increase from 21/1000 to 94/1000 per month (OR 2.09, 95% CI 1.92 to 2.27), the trends before and after interventions were 0.

Rate of new antidepressant prescribing in these patients (provision outcome)

‐

‐

‐

‐

Rates of prescribing increased over the full period of observation. The trends before and after interventions were similar.

Chien 2012

Rate of patients receiving glycated haemoglobin testing (patient outcome, utilisation)

‐

‐

‐

‐

After the intervention the adjusted RR 1.00 (95% CI 0.94 to 1.04)

Rate of patients receiving lipid testing (patient outcome, utilisation)

‐

‐

‐

‐

After the intervention the adjusted RR 1.02 (95% CI 0.99 to 1.04)

Rate of patients receiving dilated eye exam (patient outcome, utilization)

‐

‐

‐

‐

After the intervention the adjusted RR 0.95 (95% CI 0.84 to 1.05)

Comparison 3: Capitation vs FFS

Study

Immediate change in level

Change in trend

Other effects results reported by authors

Estimate

Confidence interval

Estimate

Confidence interval

Catalano 2005, ITS

Number of emergency visits in not‐for‐profit health centres' area (patient outcome, health)

‐7.422

‐12.808 to ‐2.036

‐0.332

‐0.510 to ‐0.154

‐

Number of emergency visits in for‐profit health centres' area (patient outcome, health)

‐5.305

‐12.861 to 2.251

‐0.164

‐0.419 to 0.091

‐

Catalano 2000, ITS

Number of people in outpatient treatment (provision outcome)

‐

‐

‐

‐

Weekly mean increase from 1196 before to 1299 after the intervention in for‐profit community health centres, the difference between real and expected level from history trend being 82.92, P < 0.01. No effects on not‐for‐profit community health centres.

Number of very young (< 5 years old) children in treatment (provision outcome)

‐

‐

‐

‐

Weekly mean increase from 94 before intervention to 100 after intervention in for‐profit community health centres, the difference between real and expected level from history trend being 18.53, P < 0.01. No effects on not‐for‐profit community health centres.

Number of children who receive treatment for disruptive behaviour (provision outcome)

‐

‐

‐

‐

Weekly mean increase from 287 before intervention to 318 after intervention in for‐profit community health centres, the difference between real and expected level from history trend being 72, P < 0.01. No effects on not‐for‐profit community health centres.

Number of inpatients treated (patient outcome, health)

‐

‐

‐

‐

Weekly mean decrease from 77 before intervention to 13 after intervention in not‐for‐profit health centres, the difference between real and expected level from history trend being ‐49,

P < 0.01, weekly mean decreasing from 96 to 45 in for‐profit health centres, the difference between real and expected level from history trend being ‐52, P < 0.01.

Number of people treated in emergency (patient outcome, health)

‐

‐

‐

‐

Weekly mean change from 7.9 to 7.6 in for‐profit community health centres, the difference between real and expected level from history trend being 6.66, P < 0.01. No effects on not‐for‐profit community health centres.

Total costs for all services

‐

‐

‐

‐

Weekly mean change from 507,796 before intervention to 534,800 after intervention, the difference between real and expected level from history trend being USD ‐211,400 in not‐for‐profit

health centres P < 0.01, weekly mean changing from 421,705 to 441,341, the difference between real and expected level from history trend being USD ‐178,500 in for‐profit health centres P < 0.01.

Total costs for inpatient care

‐

‐

‐

‐

Weekly mean change from 186,834 to 51,717, the difference between real and expected level from history trend being USD ‐134,200 in not‐for‐profit health centres P < 0.01, weekly mean changing from 216,166 to 111,238, the difference between real and expected level from history trend being USD ‐201,200 in for‐profit health centres P < 0.01.

Total outpatient costs

‐

‐

‐

‐

Weekly mean change from 205,539 to 330,102 in for‐profit health centres, the difference between real and expected level from history trend being USD 44,577, P < 0.01. No effects on not‐for‐profit community health centres.

Study

Outcome measures

Control/baseline level

Risk ratio

Confidence intervals

Utlisation outcomes

1. Rwanda Basinga 2011, CBA

Proportion of respondents having any prenatal care

96.0%

1.002

0.98, 1.03

Proportion of respondents having 4 or more prenatal care visits

11.0%

1.07

0.43, 1.72

Proportion of respondents having institutional delivery

36.0%

1.23

1.04, 1.41

Proportion of children younger than 23 months preventive visit in previous 4 weeks

0.24%

1.50

1.17, 1.83

Proportion of children aged 24 to 59 months preventive visit in previous 4 weeks

0.14%

1.79

1.42, 2.16

Proportion of children aged 12 to 23 months being fully immunised

0.63%

0.91

0.71, 1.12

Synthesised effects inside the study (fixed‐effect model)

—

1.01

0.99, 1.04

2. Afghanistan Engineer 2016, randomised trial

Percentage of current use of modern family planning methods

10.3

0.96

0.47, 1.95

Percentage of at least 1 antenatal checkup from a skilled provider

56.9

1.01

0.85, 1.20

Percentage of skilled birth attendant present at latest delivery

22.5

1.19

0.91, 1.55

Percentage of postnatal checkup within 42 days of delivery by a skilled provider

24.7

1.03

0.10, 10.39

Percentage of children received pentavalent 3 vaccination

62.0

0.95

0.90, 0.99

Synthesised effects inside the study (fixed‐effect model)

—

0.96

0.92, 1.00

Synthesised effect across the above 2 studies (random‐effects model)

—

1.11

1.02, 1.22

3. USA Roski 2003, randomised trial

Percentage of respondents reporting using any aids for smoking cessation

22.3%

0.93

—

Percentage of respondents reporting using any medication for quitting

21.6%

0.92

—

Percentage of respondents reporting using any counselling services

1.0%

1.23

—

Percentage of smoker respondents with 7‐day sustained abstinence from smoking

19.2%

1.16

—

Percentage of respondents being current non‐smokers (7‐day point prevalence)

19.2%

1.17

—

Percentage of respondents reporting intention to quit within 30 days

9.4%

1.13

—

Synthesised effects inside the study (median)

—

1.145

—

Synthesised effect across the above 3 studies (median)

—

1.01

—

Health outcomes

4. USA Bardach 2013, randomised trial

Proportion of patients with no IVD or DM getting blood pressure control

34.6%

1.14

1.03, 1.25

Proportion of patients with IVD getting blood pressure control

47.8%

0.82

0.56, 1.11

Proportion of patients with DM getting blood pressure control

11.8%

1.43

1.10, 1.84

Proportion of patients with IVD or DM getting blood pressure control

17.0%

1.29

1.06, 1.55

Proportion of general population with cholesterol control

91.4%

0.99

0.96, 1.01

Synthesised effects inside the study (fixed‐effect model)

—

1.01

0.98, 1.04

Combined health and provision outcomes

5. USA Petersen 2013, randomised trial

Percentage of patients achieving guideline‐recommended blood pressure thresholds or receiving an appropriate response to uncontrolled blood pressure (combination of provision and patients outcome measure, not used for analysis)

86%

1.04

0.98, 1.10

Synthesised effect across the above 3 studies (median)

—

1.07

—

Bardach 2013

Petersen 2013

Basinga 2011

Effects size for service provision measures

RR 1.11 (1.05, 1.17)

RR 1.01 (0.92, 1.12)

RR 1.08 (0.997, 1.15)

Design of P4P

Performance measures

Both provision and outcome measures

Both provision and outcome measures

Both provision and outcome measures

Performance target

Pay for each instance of performance measure unit

Pay for each instance of performance measure unit

Pay for each instance of performance measure unit

Size of incentive

5% of an average physician's annual salary

1.6% of an average physician's annual salary

35% increase in salary

Frequency of monitoring

Quarterly

4 months

Quarterly

Frequency of payment

Annual

4 months

Quarterly

Individual payment

Allocated to individual based on individual performance

Equally allocated to individual physician, non‐physician in team

77% of P4P fund allocated to individual personnel, but not clear how it was allocated

Resourcing (if with more funds)

Yes

Yes

No (in control facilities, the input‐based payments were increased by the average amount of P4P payments received by facilities in the intervention group)