An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes
Open accessAbstract
BACKGROUND: There is considerable interest in the effectiveness of financial incentives in the delivery of health care. Incentives may be used in an attempt to increase the use of evidence-based treatments among healthcare professionals or to stimulate health professionals to change their clinical behaviour with respect to preventive, diagnostic and treatment decisions, or both. Financial incentives are an extrinsic source of motivation and exist when an individual can expect a monetary transfer which is made conditional on acting in a particular way. Since there are numerous reviews performed within the healthcare area describing the effects of various types of financial incentives, it is important to summarise the effectiveness of these in an overview to discern which are most effective in changing health professionals' behaviour and patient outcomes. OBJECTIVES: To conduct an overview of systematic reviews that evaluates the impact of financial incentives on healthcare professional behaviour and patient outcomes. METHODS: We searched the Cochrane Database of Systematic Reviews (CDSR) (The Cochrane Library); Database of Abstracts of Reviews of Effectiveness (DARE); TRIP; MEDLINE; EMBASE; Science Citation Index; Social Science Citation Index; NHS EED; HEED; EconLit; and Program in Policy Decision-Making (PPd) (from their inception dates up to January 2010). We searched the reference lists of all included reviews and carried out a citation search of those papers which cited studies included in the review. We included both Cochrane and non-Cochrane reviews of randomised controlled trials (RCTs), controlled clinical trials (CCTs), interrupted time series (ITSs) and controlled before and after studies (CBAs) that evaluated the effects of financial incentives on professional practice and patient outcomes, and that reported numerical results of the included individual studies. Two review authors independently extracted data and assessed the methodological quality of each review according to the AMSTAR criteria. We included systematic reviews of studies evaluating the effectiveness of any type of financial incentive. We grouped financial incentives into five groups: payment for working for a specified time period; payment for each service, episode or visit; payment for providing care for a patient or specific population; payment for providing a pre-specified level or providing a change in activity or quality of care; and mixed or other systems. We summarised data using vote counting. MAIN RESULTS: We identified four reviews reporting on 32 studies. Two reviews scored 7 on the AMSTAR criteria (moderate, score 5 to 7, quality) and two scored 9 (high, score 8 to 11, quality). The reported quality of the included studies was, by a variety of methods, low to moderate. Payment for working for a specified time period was generally ineffective, improving 3/11 outcomes from one study reported in one review. Payment for each service, episode or visit was generally effective, improving 7/10 outcomes from five studies reported in three reviews; payment for providing care for a patient or specific population was generally effective, improving 48/69 outcomes from 13 studies reported in two reviews; payment for providing a pre-specified level or providing a change in activity or quality of care was generally effective, improving 17/20 reported outcomes from 10 studies reported in two reviews; and mixed and other systems were of mixed effectiveness, improving 20/31 reported outcomes from seven studies reported in three reviews. When looking at the effect of financial incentives overall across categories of outcomes, they were of mixed effectiveness on consultation or visit rates (improving 10/17 outcomes from three studies in two reviews); generally effective in improving processes of care (improving 41/57 outcomes from 19 studies in three reviews); generally effective in improving referrals and admissions (improving 11/16 outcomes from 11 studies in four reviews); generally ineffective in improving compliance with guidelines outcomes (improving 5/17 outcomes from five studies in two reviews); and generally effective in improving prescribing costs outcomes (improving 28/34 outcomes from 10 studies in one review). AUTHORS' CONCLUSIONS: Financial incentives may be effective in changing healthcare professional practice. The evidence has serious methodological limitations and is also very limited in its completeness and generalisability. We found no evidence from reviews that examined the effect of financial incentives on patient outcomes.
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Costly pay-for-performance interventions appear to influence short-term GP behaviour change, but not long-term, and do not appear to translate to improved patient outcomes.
“Costly pay-for-performance interventions appear to influence short-term GP behaviour change, but not long-term, and do not appear to translate to improved patient outcomes [63,64].”
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Greenhalgh, J., Dalkin, S. M., Gooding, K., Gibbons, E. J., Wright, J. M., Meads, D. M., Black, N. A., Valderas, J. M., & Pawson, R. (2017) · Health Services and Delivery Research · doi:10.3310/hsdr05020 · Cited by 238 · see citing works
“A number of systematic reviews have highlighted the variable impact of financial incentives on professional behaviour.(213,214) Pawson’s programme theory of public disclosure programmes also recognises that publicising performance data rarely works in isolation from other sanctions.”
BackgroundChauhan, B. F., Jeyaraman, M., Mann, A. S., Lys, J., Skidmore, B., Sibley, K. M., Abou-Setta, A., & Zarychanksi, R. (2017) · Implementation Science · doi:10.1186/s13012-016-0538-8 · Cited by 210 · see citing works
“With regards to financial incentives, Flodgren and colleagues have reported that financial incentives may be effective in changing healthcare professional practice [168].”
BackgroundHealthcare financing systems for increasing the use of tobacco dependence treatment
van den Brand, F. A., Nagelhout, G. E., Reda, A. A., Winkens, B., Evers, S., Kotz, D., & van Schayck, O. C. P. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004305.pub5 · Cited by 217 · see citing works
Reduced Mortality with Hospital Pay for Performance in England
Sutton, M., Nikolova, S., Boaden, R., Lester, H. E., McDonald, R., & Roland, M. O. (2012) · New England Journal of Medicine · doi:10.1056/nejmsa1114951 · Cited by 207 · see citing works
Das, J. K., Kumar, R., Salam, R. A., Lassi, Z. S., & Bhutta, Z. A. (2014) · Reproductive Health · doi:10.1186/1742-4755-11-s2-s4 · Cited by 179 · see citing works
Impact of Accountable Care Organizations on Utilization, Care, and Outcomes: A Systematic Review
Kaufman, B. G., Spivack, B. S., Stearns, S. C., Song, P. H., & O’Brien, E. C. (2019) · Medical Care Research and Review · doi:10.1177/1077558717745916 · Cited by 174 · see citing works
“Similar to ACOs, P4P programs have been associated with small positive effects on the process measures targeted; however, neither model has demonstrated consistent effects on health outcomes (Flodgren et al., 2011; Gilmore et al., 2007; Lin, Yin, Huang, & Du, 2016; Mendelson et al., 2017; Rosenthal & Frank, 2006; Rose…”
BackgroundResultRojon, C., Okupe, A., & McDowall, A. (2021) · International Journal of Management Reviews · doi:10.1111/ijmr.12245 · Cited by 192 · see citing works
Systematic review of clinician-directed nudges in healthcare contexts
Last, B. S., Buttenheim, A. M., Timon, C. E., Mitra, N., & Beidas, R. S. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-048801 · Cited by 170 · see citing works
The Science of Using Science: Researching the Use of Research Evidence in Decision-Making
Langer, L., Tripney, J., & Gough, D. (2016) · UCL Discovery (University College London) · Cited by 166 · see citing works
Why are we failing to implement effective therapies in cardiovascular disease?
Nieuwlaat, R., Schwalm, J.-D., Khatib, R., & Yusuf, S. (2013) · European Heart Journal · doi:10.1093/eurheartj/ehs481 · Cited by 152 · see citing works
How to Begin a Quality Improvement Project
Silver, S. A., Harel, Z., McQuillan, R., Weizman, A. V., Thomas, A., Chertow, G. M., NESRALLAH, G. E., Bell, C. M., & Chan, C. T. (2016) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.11491015 · Cited by 151 · see citing works
Ryan, A. M., Krinsky, S., Kontopantelis, E., & Doran, T. (2016) · The Lancet · doi:10.1016/s0140-6736(16)00276-2 · Cited by 151 · see citing works
Ballard, M., & Montgomery, P. (2017) · Research Synthesis Methods · doi:10.1002/jrsm.1229 · Cited by 136 · see citing works
“…conditions or populations (e.g. Steultjens et al., 2005), (3) multiple outcomes of the same intervention for the same condition or population (e.g. Flodgren et al., 2011), or (4) adverse effects from Centre for Evidence-Based Intervention, University of Oxford, Oxford, UK *Correspondence to:…”
BackgroundHarrison, M. J., Dusheiko, M., Sutton, M., Gravelle, H. S. E., Doran, T., & Roland, M. O. (2014) · BMJ · doi:10.1136/bmj.g6423 · Cited by 140 · see citing works
Institute of Medicine (2013) · National Academies Press eBooks · doi:10.17226/13444 · Cited by 150 · see citing works
Adler, A. J., Prabhakaran, D., Bovet, P., Kazi, D. S., Mancia, G., Mungal-Singh, V., & Poulter, N. R. (2015) · Global Heart · doi:10.1016/j.gheart.2015.04.006 · Cited by 133 · see citing works
“Low awareness and control The PURE study showed low levels of awareness, treatment and control of hypertension in all regions of the world (Table 2) [8].”
BackgroundInfluentialWorswick, J., Wayne, S. C., Bennett, R., Fiander, M., Mayhew, A., Weir, M. C., Sullivan, K. J., & Grimshaw, J. M. (2013) · Systematic Reviews · doi:10.1186/2046-4053-2-26 · Cited by 130 · see citing works
“This is a challenging undertaking considering that overview methods are still evolving and a variety of approaches are being used [20,76,77].”
BackgroundThe effect of different methods of remuneration on the behaviour of primary care dentists
Brocklehurst, P. R., Price, J., Glenny, A., Tickle, M., Birch, S., Mertz, E., & Grytten, J. I. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009853.pub2 · Cited by 118 · see citing works
Li, X., Zheng, Y., Chen, Y., Yang, K., & Zhang, Z. (2014) · Health Policy · doi:10.1016/j.healthpol.2014.09.002 · Cited by 114 · see citing works
Sullivan, F., Farmer, E. C. W., Mair, F. S., Treweek, S. P., Kendrick, D., Jackson, C., Robertson, C., Briggs, A. H., McCowan, C., Bedford, L. E., et al. (2017) · BMC Cancer · doi:10.1186/s12885-017-3175-y · Cited by 108 · see citing works
“Main study The rate of lung cancer was 187/100,000 per year for patients aged 50 – 74 in Scotland 2008 which is higher than many other similar countries [23].”
Patient-mediated interventions to improve professional practice
Fønhus, M. S., Dalsbø, T. K., Johansen, M., Fretheim, A., Skirbekk, H., & Flottorp, S. A. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012472.pub2 · Cited by 107 · see citing works
Pollock, M., Fernandes, R. M., & Hartling, L. (2017) · BMC Medical Research Methodology · doi:10.1186/s12874-017-0325-5 · Cited by 107 · see citing works
“For descriptive purposes, AMSTAR assessments were divided into categories using established criteria (AMSTAR assessments of 0-3, 4-7, and 8-11) [17, 35, 36].”
MethodMorgan, H. M., Hoddinott, P., Thomson, G., Crossland, N., Farrar, S., Yi, D., Hislop, J., Morán, V. H., MacLennan, G., Dombrowski, S. U., et al. (2015) · Health Technology Assessment · doi:10.3310/hta19300 · Cited by 108 · see citing works
Kontopantelis, E., Springate, D. A., Ashworth, M. J., Webb, R. T., Buchan, I. E., & Doran, T. (2015) · BMJ · doi:10.1136/bmj.h904 · Cited by 99 · see citing works
Morgan, D. J., Leppin, A. L., Smith, C. D., & Korenstein, D. R. (2017) · Journal of Hospital Medicine · doi:10.12788/jhm.2738 · Cited by 99 · see citing works
Inclusion of quasi-experimental studies in systematic reviews of health systems research
Rockers, P. C., Røttingen, J., Shemilt, I., Tugwell, P., & Bärnighausen, T. (2014) · Health Policy · doi:10.1016/j.healthpol.2014.10.006 · Cited by 98 · see citing works
“Systematic reviews have recently been conducted on a wide variety of health systems topics, including health care provider payment systems [2–4], demand-side incentives for health care use [5,6], and clinical task shifting [7–9].”
BackgroundEnglish, M. (2013) · Implementation Science · doi:10.1186/1748-5908-8-39 · Cited by 97 · see citing works
Zoubi, F. A., Menon, A., Mayo, N. E., & Bussières, A. (2018) · BMC Health Services Research · doi:10.1186/s12913-018-3253-0 · Cited by 97 · see citing works
Egerton, T., Nelligan, R. K., Setchell, J., Atkins, L., & Bennell, K. L. (2018) · BMC Rheumatology · doi:10.1186/s41927-018-0037-4 · Cited by 91 · see citing works
When financial incentives do more good than harm: a checklist
Glasziou, P., Buchan, H., Mar, C. D., Doust, J. A., Harris, M., Knight, R., Scott, A., Scott, I. A., & Stockwell, A. (2012) · BMJ · doi:10.1136/bmj.e5047 · Cited by 90 · see citing works
Self-citationThe Early Effects of Medicare's Mandatory Hospital Pay‐for‐Performance Program
Ryan, A. M., Burgess, J. F., Pesko, M. F., Borden, W. B., & Dimick, J. B. (2014) · Health Services Research · doi:10.1111/1475-6773.12206 · Cited by 89 · see citing works
Potthoff, S., Rasul, O., Sniehotta, F. F., Marques, M. M., Beyer, F. R., Thomson, R., Avery, L., & Presseau, J. (2019) · Health Psychology Review · doi:10.1080/17437199.2018.1547119 · Cited by 87 · see citing works
“For example, providing healthcare professionals with financial rewards when they engage in a particular practice may positively reinforce that behaviour and lead to repetition, thus promoting habit formation (Flodgren et al., 2011).”
Self-citationDatabase combinations to retrieve systematic reviews in overviews of reviews: a methodological study
Gooßen, K., Heß, S., Lunny, C., & Pieper, D. (2020) · BMC Medical Research Methodology · doi:10.1186/s12874-020-00983-3 · Cited by 88 · see citing works
Chambers, C. T. (2018) · Pain · doi:10.1097/j.pain.0000000000001327 · Cited by 88 · see citing works
Incentives to change: effects of performance-based financing on health workers in Zambia
Shen, G. C., Nguyen, H. T. H., Das, A., Sachingongu, N., Chansa, C., Qamruddin, J. N., & Friedman, J. A. (2017) · Human Resources for Health · doi:10.1186/s12960-017-0179-2 · Cited by 84 · see citing works
“Incentives can be a source of motivation because an individual or an organization would perform an action in order to attain a valued resource [17].”
BackgroundTurcotte‐Tremblay, A., Spagnolo, J., Allegri, M. D., & Ridde, V. (2016) · Health Economics Review · doi:10.1186/s13561-016-0103-9 · Cited by 83 · see citing works
Impact of Provider Incentives on Quality and Value of Health Care
Doran, T., Maurer, K. A., & Ryan, A. M. (2015) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-032315-021457 · Cited by 83 · see citing works
“reviews of 32 studies, concluded that financial incentives were generally effective at improving targeted process of care, but there was little evidence for improved patient outcomes (37).”
BackgroundEffectiveness of a Brief, Basic Evidence‐Based Practice Course for Clinical Nurses
Ramos‐Morcillo, A. J., Fernández‐Salazar, S., Ruzafa‐Martínez, M., & Casado, R. D. P. (2015) · Worldviews on Evidence-Based Nursing · doi:10.1111/wvn.12103 · Cited by 77 · see citing works
Robertson, C. T., Rose, S. L., & Kesselheim, A. S. (2012) · The Journal of Law Medicine & Ethics · doi:10.1111/j.1748-720x.2012.00678.x · Cited by 73 · see citing works
Financial Incentives to Encourage Value-Based Health Care
Scott, A., Liu, M., & Yong, J. (2016) · Medical Care Research and Review · doi:10.1177/1077558716676594 · Cited by 73 · see citing works
“2014; Houle, McAlister, Jackevicius, Chuck, and Tsuyuki 2012), and reviews of those reviews (Eijkenaar, Emmert, Scheppach, and Schoffski 2013; Flodgren et al. 2011).”
BackgroundSelf-citationVeenstra, G. L., Dabekaussen, K. F. A. A., Molleman, E., Heineman, E., & Welker, G. A. (2020) · Health Care Management Review · doi:10.1097/hmr.0000000000000284 · Cited by 67 · see citing works
“, public reporting) as a means to extrinsically motivate health care professionals to improve quality and potentially explain why these methods have not reached their anticipated success (Berenson & Rice, 2015; Flodgren et al., 2011; Franco et al., 2002).”
BackgroundInfluentialSetting performance targets in pay for performance programmes: what can we learn from QOF?
Doran, T., Kontopantelis, E., Reeves, D., Sutton, M., & Ryan, A. M. (2014) · BMJ · doi:10.1136/bmj.g1595 · Cited by 66 · see citing works
Impact of reimbursement systems on patient care – a systematic review of systematic reviews
Wagenschieber, E., & Blunck, D. (2024) · Health Economics Review · doi:10.1186/s13561-024-00487-6 · Cited by 66 · see citing works
“Other reviews have addressed effects on patient care in outpatient settings [6] or included studies from developing countries in their evaluations [7].”
BackgroundKoleva‐Kolarova, R., Buchanan, J., Vellekoop, H., Huygens, S. A., Versteegh, M., Mölken, M. R., Szilberhorn, L., Zelei, T., Nagy, B., Wordsworth, S., et al. (2022) · Applied Health Economics and Health Policy · doi:10.1007/s40258-021-00714-9 · Cited by 68 · see citing works
Pay-for-Performance: Toxic to Quality? Insights from Behavioral Economics
Himmelstein, D. U., Ariely, D., & Woolhandler, S. J. (2014) · International Journal of Health Services · doi:10.2190/hs.44.2.a · Cited by 65 · see citing works
Bérubé, M., Poitras, S., Bastien, M., Laliberté, L.-A., Lacharité, A., & Gross, D. P. (2017) · Physiotherapy · doi:10.1016/j.physio.2017.05.002 · Cited by 66 · see citing works
Changing Provider Behavior in the Context of Chronic Disease Management: Focus on Clinical Inertia
Lavoie, K., Rash, J. A., & Campbell, T. S. (2016) · The Annual Review of Pharmacology and Toxicology · doi:10.1146/annurev-pharmtox-010716-104952 · Cited by 63 · see citing works
Overview of systematic reviews - a new type of study: part I: why and for whom?
Silva, V., Grande, A. J., Martimbianco, A. L. C., Riera, R., & de Carvalho, A. P. V. (2012) · Sao Paulo Medical Journal · doi:10.1590/s1516-31802012000600007 · Cited by 61 · see citing works
Social preferences of future physicians
Li, J., Dow, W. H., & Kariv, S. (2017) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1705451114 · Cited by 61 · see citing works
How effects on health equity are assessed in systematic reviews of interventions
Welch, V., Dewidar, O., Ghogomu, E. T., Abdisalam, S., Ameer, A. A., Barbeau, V. I., Brand, K., Kebedom, K., Benkhalti, M., Kristjansson, E., et al. (2022) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.mr000028.pub3 · Cited by 65 · see citing works
Payment methods for outpatient care facilities
Yuan, B., He, L., Meng, Q., & Jia, L. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011153.pub2 · Cited by 60 · see citing works
Caries risk/susceptibility assessment: its value in minimum intervention oral healthcare
Doméjean, S., Banerjee, A., & Featherstone, J. D. B. (2017) · BDJ · doi:10.1038/sj.bdj.2017.665 · Cited by 58 · see citing works
Francetic, I. N. ;., Meacock, R., Elliott, J., Kristensen, S. R., Britteon, P., Lugo-Palacios, D. G., Wilson, P. M., & Sutton, M. (2022) · Implementation Science Communications · doi:10.1186/s43058-022-00280-8 · Cited by 56 · see citing works
“A substantial literature has shown that care processes improved for these patients on the incentivised aspects of care, suggesting that the policy achieved the targeted effect [37, 52, 53].”
BackgroundRealigning Demand and Supply Side Incentives to Improve Primary Health Care Seeking in Rural China
Powell‐Jackson, T., Yip, W. C.-M., & Han, W. (2014) · Health Economics · doi:10.1002/hec.3060 · Cited by 53 · see citing works
Halpern, M. T., Romaire, M. A., Haber, S. G., Tangka, F. K. L., Sabatino, S. A., & Howard, D. H. (2014) · Cancer · doi:10.1002/cncr.28704 · Cited by 53 · see citing works
Promotion of rapid testing for HIV in primary care (RHIVA2): a cluster-randomised controlled trial
Leber, W., McMullen, H., Anderson, J., Marlin, N., Santos, A. C., Bremner, S. A., Boomla, K., Kerry, S., Millett, D., Mguni, S., et al. (2015) · The Lancet HIV · doi:10.1016/s2352-3018(15)00059-4 · Cited by 53 · see citing works
“The effectiveness of outreach visits, and clinician education combining mixed didactic and interactive elements, is well established.(26) Computer prompts to testing and incentive fees may also have enhanced behaviour change.”
Wilson, P. M., & Kislov, R. (2022) · Cambridge University Press eBooks · doi:10.1017/9781009237055 · Cited by 52 · see citing works
Value-Based Purchasing Design And Effect: A Systematic Review And Analysis
Pandey, A., Eastman, D., Hsu, H., Kerrissey, M. J., Rosenthal, M. B., & Chien, A. T. (2023) · Health Affairs · doi:10.1377/hlthaff.2022.01455 · Cited by 52 · see citing works
Belogianni, K., & Baldwin, C. (2019) · Advances in Nutrition · doi:10.1093/advances/nmz027 · Cited by 52 · see citing works
“A similar decision rule has been used in other overviews (19).”
MethodPayment methods for healthcare providers working in outpatient healthcare settings
Jia, L., Meng, Q., Scott, A., Yuan, B., & Zhang, L. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011865.pub2 · Cited by 49 · see citing works
Self-citationStacey, F. G., Finch, M., Wolfenden, L., Grady, A., Jessop, K., Wedesweiler, T., Bartlem, K. M., Jones, J. Z., Sutherland, R., Vandevijvere, S., et al. (2017) · Current Nutrition Reports · doi:10.1007/s13668-017-0212-z · Cited by 49 · see citing works
Healthcare financing systems for increasing the use of tobacco dependence treatment
Reda, A. A., Kotz, D., Evers, S., & van Schayck, O. C. P. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004305.pub4 · Cited by 48 · see citing works
Enhancing primary care and preventive services through Interprofessional practice and education
Fowler, T., Garr, D. R., Mager, N. A. D., & Stanley, J. M. (2020) · Israel Journal of Health Policy Research · doi:10.1186/s13584-020-00371-8 · Cited by 47 · see citing works
Campbell, L., Novak, I., McIntyre, S. J., & Lord, S. J. (2013) · Implementation Science · doi:10.1186/1748-5908-8-132 · Cited by 47 · see citing works
“Our chosen measurement instrument (GAS) was sensitive to change [56,57] and appeared accurate as self- and peer-”
MethodWittich, L., Tsatsaronis, C., Kuklinski, D., Schöner, L., Steinbeck, V., Busse, R., & Rombey, T. (2024) · Value in Health · doi:10.1016/j.jval.2024.05.013 · Cited by 44 · see citing works
McNulty, C. A. M., Hogan, A. H., Ricketts, E. J., WALLACE, L. M., Oliver, I., Campbell, R. M., Kalwij, S., O'Connell, E. E., & Charlett, A. (2013) · Sexually Transmitted Infections · doi:10.1136/sextrans-2013-051029 · Cited by 44 · see citing works
Li, J. (2018) · Journal of Health Economics · doi:10.1016/j.jhealeco.2018.09.005 · Cited by 44 · see citing works
Evaluation of a Peer-to-Peer Data Transparency Intervention for Mohs Micrographic Surgery Overuse
Albertini, J. G., Wang, P., Fahim, C., Hutfless, S. M., Stasko, T., Vidimos, A. T., Leshin, B., Billingsley, E. M., Coldiron, B. M., Bennett, R. G., et al. (2019) · JAMA Dermatology · doi:10.1001/jamadermatol.2019.1259 · Cited by 44 · see citing works
Doran, T., Kontopantelis, E., Fullwood, C., Lester, H. E., Valderas, J. M., & Campbell, S. (2012) · BMJ · doi:10.1136/bmj.e2405 · Cited by 43 · see citing works
Integrated community case management of childhood illness in low- and middle-income countries
Oliphant, N. P., Manda, S., Daniels, K., Odendaal, W., Besada, D., Kinney, M. V., Johansson, E. W., & Doherty, T. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012882.pub2 · Cited by 45 · see citing works
Zaresani, A., & Scott, A. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06118-8 · Cited by 43 · see citing works
Self-citationThe effect of different methods of remuneration on the behaviour of primary care dentists
Brocklehurst, P. R., Tickle, M., Birch, S., Glenny, A., Mertz, E., & Grytten, J. I. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009853 · Cited by 43 · see citing works
Overview of systematic reviews - a new type of study. Part II
Silva, V., Grande, A. J., de Carvalho, A. P. V., Martimbianco, A. L. C., & Riera, R. (2014) · Sao Paulo Medical Journal · doi:10.1590/1516-3180.2013.8150015 · Cited by 42 · see citing works
“…regarding methodological quality for the following reasons: they did not record the protocol 36 or, if it was cited, did not make it available; 38 they only included searches in the Cochrane Database of Systematic Reviews (CDSR); 26,35-37,39, 43, 44, 46 Through the outcome of implications for…”
BackgroundMethodPerformance-based incentives and community health workers’ outputs, a systematic review
Gadsden, T., Mabunda, S. A., Palagyi, A., Maharani, A., Sujarwoto, S., Baddeley, M. C., & Jan, S. (2021) · Bulletin of the World Health Organization · doi:10.2471/blt.20.285218 · Cited by 42 · see citing works
Using Performance Incentives to Improve Medical Care Productivity and Health Outcomes
Gertler, P., & Vermeersch, C. M. J. (2013) · National Bureau of Economic Research · doi:10.3386/w19046 · Cited by 42 · see citing works
Impact of payment model on the behaviour of specialist physicians: A systematic review
Quinn, A. E., Trachtenberg, A. J., McBrien, K., Ogundeji, Y. K., Souri, S., Manns, L., Rennert‐May, E., Ronksley, P. E., Au, F., Arora, N., et al. (2020) · Health Policy · doi:10.1016/j.healthpol.2020.02.007 · Cited by 41 · see citing works
Beidas, R. S., Becker‐Haimes, E. M., Adams, D. R., Skriner, L. C., Stewart, R. E., Wolk, C. B., Buttenheim, A. M., Williams, N. J., Inacker, P., Richey, E., et al. (2017) · Implementation Science · doi:10.1186/s13012-017-0684-7 · Cited by 41 · see citing works
“Broadly across healthcare practices, a Cochrane Report systematic review found that financial incentives may be effective in changing healthcare professional practice, particularly when improving processes of care [22].”
BackgroundAhmed, K., Hashim, S., Khankhara, M., Said, I., Shandakumar, A., Zaman, S., & Veiga, A. (2021) · BMJ Open Quality · doi:10.1136/bmjoq-2020-001127 · Cited by 39 · see citing works
Paying hospital specialists: Experiences and lessons from eight high-income countries
Quentin, W., Geißler, A., Wittenbecher, F., Ballinger, G., Berenson, R. A., Bloor, K. E., Forgione, D. A., Köpf, P., Kroneman, M. W., Serdén, L., et al. (2018) · Health Policy · doi:10.1016/j.healthpol.2018.03.005 · Cited by 38 · see citing works
Did the new French pay-for-performance system modify benzodiazepine prescribing practices?
Rat, C., Penhouet, G., Gaultier, A., Chaslerie, A., Pivette, J., Nguyen, J., & Victorri‐Vigneau, C. (2014) · BMC Health Services Research · doi:10.1186/1472-6963-14-301 · Cited by 38 · see citing works
Duysburgh, E., Temmerman, M., Yé, M., Williams, A., Massawe, S. N., Williams, J. E., Mpembeni, R. N. M., Loukanova, S., Haefeli, W. E., & Blank, A. (2015) · Tropical Medicine & International Health · doi:10.1111/tmi.12627 · Cited by 37 · see citing works
“Various literature reviews on the impact of PBI (financial and non-financial) on quality of care in general [45, 46] and, more specifically, on quality of maternal and newborn care [47, 48] state that incentives schemes might have an impact on changing healthcare professionals’ practice and improving quality of care a…”
BackgroundImel, Z. E., Sheng, E., Baldwin, S. A., & Atkins, D. C. (2015) · Psychotherapy · doi:10.1037/pst0000023 · Cited by 37 · see citing works
“, Zhang, F., & Soumerai, S. B. (2011). Effect of pay for perfor-”
Lavergne, M. R., Law, M., Peterson, S., Garrison, S. R., Hurley, J., Cheng, L., & McGrail, K. (2017) · Health Policy · doi:10.1016/j.healthpol.2017.11.001 · Cited by 29 · see citing works
O'Donnell, A. J., Angus, C., Hanratty, B., Hamilton, F. L., Petersen, I., & Kaner, E. (2019) · Addiction · doi:10.1111/add.14778 · Cited by 37 · see citing works
“However, evidence of their impact on the quality and efficiency of healthcare remains inconclusive, particularly where long-term patient outcomes are concerned (20-23).”
BackgroundThe proportion of randomized controlled trials that inform clinical practice
Hutchinson, N., Moyer, H., Zarin, D. A., & Kimmelman, J. (2022) · eLife · doi:10.7554/elife.79491 · Cited by 37 · see citing works
Lassi, Z. S., Salam, R. A., Das, J. K., & Bhutta, Z. A. (2014) · Infectious Diseases of Poverty · doi:10.1186/2049-9957-3-22 · Cited by 37 · see citing works
Ryan, A. M., Sutton, M., & Doran, T. (2013) · Health Services Research · doi:10.1111/1475-6773.12097 · Cited by 36 · see citing works
“The effects of P4P on provider behavior have been extensively studied (Petersen et al. 2006; Mehrotra et al. 2009; Van Herck et al. 2010; Flodgren et al. 2011).”
Background
- Authors
- Flodgren, G., Eccles, M. P., Shepperd, S., Scott, A., Parmelli, E., & Beyer, F. R.
- Affiliations
- University of Oxford (GB)
- Newcastle University (GB)
- The University of Melbourne (AU)
- University of Modena and Reggio Emilia (IT)
- University of York (GB)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2011-07-06
- Volume
- 2011
- Issue
- 7
- Pages
- CD009255-CD009255
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC4204491
- OpenAlex
- W1875145339
- Cited by
- 418
- References
- 83
- Citations by year
- 2026: 5 · 2025: 19 · 2024: 20 · 2023: 10 · 2022: 23 · 2021: 32 · 2020: 27 · 2019: 29 · 2018: 30 · 2017: 49 · 2016: 29 · 2015: 44 · 2014: 41 · 2013: 39 · 2012: 17
- FWCI
- 5.36
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- National Institute for Health and Care Research (10/4001/03)
- Topics
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- financial incentives, healthcare professional behaviour, patient outcomes, performance-based pay, fee-for-service, quality of care, evidence-based practice, extrinsic motivation, health care delivery, vote counting, health policy evaluation, health professions education, health professions workforce
- MeSH terms
- Capitation Fee, Delivery of Health Care, Humans, Motivation, Professional Practice, Review Literature as Topic, Salaries and Fringe Benefits, Treatment Outcome, Fee-for-Service Plans
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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