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Health Policy and Planning Advance Access published online on February 7, 2009
Health Policy and Planning, doi:10.1093/heapol/czp002
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Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2009; all rights reserved.

Performance-based payment: some reflections on the discourse, evidence and unanswered questions

Cynthia Eldridge1,* and Natasha Palmer2

1Department of Planning and Policy Development, Ministry of Health, Lilongwe, Malawi.
2Lecturer, Health Economics and Financing Programme, London School of Hygiene and Tropical Medicine, UK.

* Corresponding author. Department of Planning and Policy Development, Ministry of Health, P.O. Box 30377, Lilongwe 3, Malawi. Tel: +265 (0) 1789 563. Fax: +265 (0) 1789 527. E-mail: cynthia{at}cynbe.com

Performance-based payment (PBP) is increasingly advocated as a way to improve the performance of health systems in low-income countries. This study conducted a systematic review of the current literature on this topic and found that while it is a popular term, there was little consensus about the meaning or the use of the concept of PBP. Significant weaknesses in the current evidence base on the success of PBP initiatives were also found. The literature would be strengthened by multi-disciplinary case studies that present both the advantages and disadvantages of PBP, influential factors for success, and more details about the projects from which this evidence is drawn. Where possible, data from control facilities where PBP is not being implemented would be an important addition. This paper suggests a further agenda for research, including assessing optimal conditions for implementation of PBP schemes in less developed health systems, the impact of adopting measures of performance as targets, and the requirements for monitoring PBP adequately.

Key Words: Performance-based payment, contracting, health care delivery, health care financing, low-income countries, developing countries

Accepted for publication 27 October 2008.


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