Cited by 418Primary Care and Health OutcomesHealthcare Policy and ManagementHealth Policy Implementation Science

The DOI matches its Crossref record; 78 of the 83 references it cites were found in a registry or an index.

An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes

Open access

Flodgren, Gerd, Eccles, Martin P, Shepperd, Sasha, Scott, Anthony, Parmelli, Elena, Beyer, Fiona R·2011·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd009255PMC PMC4204491

Open this paper in CoChat — free account

Abstract

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.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

Integrity signals

Registry

Crossref · 10.1002/14651858.cd009255

Cites

78 of 79 references verified1 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.
(2009) · PubMed Central · Cited by 44,859
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2009.06.005 · Cited by 19,575
Grading quality of evidence and strength of recommendations
(2004) · BMJ · doi:10.1136/bmj.328.7454.1490 · Cited by 8,477
Self-citation
The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions.
Downs, S. H., & Black, N. (1998) · Journal of Epidemiology and Community Health · doi:10.1136/jech.52.6.377 · Cited by 8,252
Quasi-experimentation: Design and analysis issues for field settings
Shrout, P. E. (1980) · Evaluation and Program Planning · doi:10.1016/0149-7189(80)90063-4 · Cited by 6,091
Development of AMSTAR: A measurement tool to assess the methodological quality of systematic reviews
Shea, B. J., Grimshaw, J. M., Wells, G. A., Boers, M., Andersson, N., Hamel, C., Porter, A. C., Tugwell, P., Moher, D., & Bouter, L. M. (2007) · BMC Medical Research Methodology · doi:10.1186/1471-2288-7-10 · Cited by 4,374
Performance Pay and Productivity
Lazear, E. P. (2000) · American Economic Review · doi:10.1257/aer.90.5.1346 · Cited by 2,491
Not just for the money: an economic theory of personal motivation
(1997) · Choice Reviews Online · doi:10.5860/choice.35-1009 · Cited by 1,956
Does Pay-for-Performance Improve the Quality of Health Care?
Petersen, L. A., Woodard, L., Urech, T. H., Daw, C., & Chitwood, S. S. (2006) · Annals of Internal Medicine · doi:10.7326/0003-4819-145-4-200608150-00006 · Cited by 698

Flagged first, then by citations

Show all 83 references

4 of the 83 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

Christianson J Leatherman S Sutherland K Financial incentives, healthcare providers and quality improvements- a review of the evidence The Health Foundation 2007 7 105
Bero L Eccles M Grilli R Grimshaw J Gruen RL Mayhew A Cochrane Effective Practice and Organisation of Care Group. About The Cochrane Collaboration (Cochrane Review groups (CRGs)) Cochrane Effective Practice and Organisation of Care Group 2008
Burr, 1992, Impact of fundholding on general practice prescribing patterns, Pharmaceutical Journal, 249 Suppl, R8
World Health Organization, 2006, Quality of care - a process for making strategic choices in health systems

Sorted by citations

Best care at lower cost: the path to continuously learning health care in America
Smith, M. A., Saunders, R., Stuckhardt, L., & McGinnis, J. M. (2014) · Choice Reviews Online · doi:10.5860/choice.51-3277 · Cited by 1,357
Methodology in conducting a systematic review of systematic reviews of healthcare interventions
Smith, V., Devane, D., Begley, C. M., & Clarke, M. (2011) · BMC Medical Research Methodology · doi:10.1186/1471-2288-11-15 · Cited by 1,227
Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide
Miller, S., Abalos, E., Chamillard, M., Ciapponi, A., Colaci, D., Comandé, D., Diaz, V., Geller, S., Hanson, C., Langer, A., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(16)31472-6 · Cited by 1,181
Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis
Levit, L. A., Balogh, E. P., Nass, S. J., & Ganz, P. A. (2014) · Cited by 956
Stemming the Superbug Tide
OECD (2018) · OECD health policy studies · doi:10.1787/9789264307599-en · Cited by 781
Is volunteering a public health intervention? A systematic review and meta-analysis of the health and survival of volunteers
Jenkinson, C. E., Dickens, A. P., Jones, K., Thompson-Coon, J., Taylor, R. S., Rogers, M., Bambra, C. L., Lang, I., & Richards, S. H. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-773 · Cited by 730
Who Adopts Improved Fuels and Cookstoves? A Systematic Review
Lewis, J., & Pattanayak, S. K. (2012) · Environmental Health Perspectives · doi:10.1289/ehp.1104194 · Cited by 583
“…for a systematic assessment of studies within a given research area, and this methodology has been popular in medicine (Cook et al. 1992; Hölzel et al. 2011), natural resource management (Beach et al. 2005; Pattanayak et al. 2003), and public health (Flodgren et al. 2011; Gerrard et al. 1996).”
Background
Effects of pay for performance in health care: A systematic review of systematic reviews
Eijkenaar, F., Emmert, M., Scheppach, M., & Schöffski, O. (2013) · Health Policy · doi:10.1016/j.healthpol.2013.01.008 · Cited by 562
The Lancet Global Health Commission on financing primary health care: putting people at the centre
Hanson, K., Brikci, N., Erlangga, D., Alebachew, A., De Allegri, M., Balabanova, D., Blecher, M., Cashin, C., Esperato, A., Hipgrave, D., et al. (2022) · The Lancet Global Health · doi:10.1016/s2214-109x(22)00005-5 · Cited by 525
The Effectiveness of Financial Incentives for Health Behaviour Change: Systematic Review and Meta-Analysis
Giles, E. L., Robalino, S., McColl, E., Sniehotta, F. F., & Adams, J. (2014) · PLoS ONE · doi:10.1371/journal.pone.0090347 · Cited by 470
“The reference lists of relevant previous reviews [11,17,18,21– 23,26–46] and all papers meeting the inclusion criteria [47–63] were also reviewed.”
Management of Bureaucrats and Public Service Delivery: Evidence from the Nigerian Civil Service
Imran Rasul, A., & Rogger, D. (2016) · The Economic Journal · doi:10.1111/ecoj.12418 · Cited by 462
Implementability of healthcare interventions: an overview of reviews and development of a conceptual framework
Klaic, M., Kapp, S., Hudson, P., Chapman, W. W., Denehy, L., Story, D., & Francis, J. (2022) · Implementation Science · doi:10.1186/s13012-021-01171-7 · Cited by 443
Systematic review of knowledge translation strategies in the allied health professions
Scott, S. D., Albrecht, L., O’Leary, K., Ball, G. D., Hartling, L., Hofmeyer, A., Jones, C. A., Klassen, T. P., Burns, K. K., Newton, A. S., et al. (2012) · Implementation Science · doi:10.1186/1748-5908-7-70 · Cited by 331
Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care
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 253
“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.”
Background
Behavior change interventions and policies influencing primary healthcare professionals’ practice—an overview of reviews
Chauhan, 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
“With regards to financial incentives, Flodgren and colleagues have reported that financial incentives may be effective in changing healthcare professional practice [168].”
Background
Healthcare 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
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
Evidence from facility level inputs to improve quality of care for maternal and newborn health: interventions and findings
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 180
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
“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…”
BackgroundResult
Utilization and development of systematic reviews in management research: What do we know and where do we go from here?
Rojon, C., Okupe, A., & McDowall, A. (2021) · International Journal of Management Reviews · doi:10.1111/ijmr.12245 · Cited by 192
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 173
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 164
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 155
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
Long-term evidence for the effect of pay-for-performance in primary care on mortality in the UK: a population study
Ryan, A. M., Krinsky, S., Kontopantelis, E., & Doran, T. (2016) · The Lancet · doi:10.1016/s0140-6736(16)00276-2 · Cited by 151
Risk of bias in overviews of reviews: a scoping review of methodological guidance and four‐item checklist
Ballard, M., & Montgomery, P. (2017) · Research Synthesis Methods · doi:10.1002/jrsm.1229 · Cited by 136
“…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:…”
Background
Effect of a national primary care pay for performance scheme on emergency hospital admissions for ambulatory care sensitive conditions: controlled longitudinal study
Harrison, 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
Best Care at Lower Cost
Institute of Medicine (2013) · National Academies Press eBooks · doi:10.17226/13444 · Cited by 161
Reducing Cardiovascular Mortality Through Prevention and Management of Raised Blood Pressure: A World Heart Federation Roadmap
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
“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].”
BackgroundInfluential
Improving quality of care for persons with diabetes: an overview of systematic reviews - what does the evidence tell us?
Worswick, 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
“This is a challenging undertaking considering that overview methods are still evolving and a variety of approaches are being used [20,76,77].”
Background
The 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
The reporting characteristics and methodological quality of Cochrane reviews about health policy research
Li, X., Zheng, Y., Chen, Y., Yang, K., & Zhang, Z. (2014) · Health Policy · doi:10.1016/j.healthpol.2014.09.002 · Cited by 114
Detection in blood of autoantibodies to tumour antigens as a case-finding method in lung cancer using the EarlyCDT®-Lung Test (ECLS): study protocol for a randomized controlled trial
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
“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
Evaluation of AMSTAR to assess the methodological quality of systematic reviews in overviews of reviews of healthcare interventions
Pollock, M., Fernandes, R. M., & Hartling, L. (2017) · BMC Medical Research Methodology · doi:10.1186/s12874-017-0325-5 · Cited by 113
“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].”
Method
Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design
Morgan, 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 110
Investigating the relationship between quality of primary care and premature mortality in England: a spatial whole-population study
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 105
A Practical Framework for Understanding and Reducing Medical Overuse: Conceptualizing Overuse Through the Patient‐Clinician Interaction
Morgan, D. J., Leppin, A. L., Smith, C. D., & Korenstein, D. R. (2017) · Journal of Hospital Medicine · doi:10.12788/jhm.2738 · Cited by 105
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 110
“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].”
Background
Designing a theory-informed, contextually appropriate intervention strategy to improve delivery of paediatric services in Kenyan hospitals
English, M. (2013) · Implementation Science · doi:10.1186/1748-5908-8-39 · Cited by 97
The effectiveness of interventions designed to increase the uptake of clinical practice guidelines and best practices among musculoskeletal professionals: a systematic review
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
General practitioners’ views on managing knee osteoarthritis: a thematic analysis of factors influencing clinical practice guideline implementation in primary care
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
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 93
Self-citation
The 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
The relationship between habit and healthcare professional behaviour in clinical practice: a systematic review and meta-analysis
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 94
“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-citation
Database 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 96
From evidence to influence: dissemination and implementation of scientific knowledge for improved pain research and management
Chambers, C. T. (2018) · Pain · doi:10.1097/j.pain.0000000000001327 · Cited by 91
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
“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].”
Background
Does performance-based financing increase value for money in low- and middle- income countries? A systematic review
Turcotte‐Tremblay, A., Spagnolo, J., Allegri, M. D., & Ridde, V. (2016) · Health Economics Review · doi:10.1186/s13561-016-0103-9 · Cited by 83
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 86
“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).”
Background
Effectiveness 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
Effect of Financial Relationships on the Behaviors of Health Care Professionals: A Review of the Evidence
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
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
“2014; Houle, McAlister, Jackevicius, Chuck, and Tsuyuki 2012), and reviews of those reviews (Eijkenaar, Emmert, Scheppach, and Schoffski 2013; Flodgren et al. 2011).”
BackgroundSelf-citation
Health care professionals’ motivation, their behaviors, and the quality of hospital care: A mixed-methods systematic review
Veenstra, 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
“, 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).”
BackgroundInfluential
Setting 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
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
“Other reviews have addressed effects on patient care in outpatient settings [6] or included studies from developing countries in their evaluations [7].”
Background
Financing and Reimbursement Models for Personalised Medicine: A Systematic Review to Identify Current Models and Future Options
Koleva‐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
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
Strategies to translate knowledge related to common musculoskeletal conditions into physiotherapy practice: a systematic review
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 70
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
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
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 60
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 68
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
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
Framework for identification and measurement of spillover effects in policy implementation: intended non-intended targeted non-targeted spillovers (INTENTS)
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
“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].”
Background
Realigning 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
Impact of state‐specific Medicaid reimbursement and eligibility policies on receipt of cancer screening
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
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
“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.”
Implementation Science
Wilson, P. M., & Kislov, R. (2022) · Cambridge University Press eBooks · doi:10.1017/9781009237055 · Cited by 58
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
Types of Interventions Targeting Dietary, Physical Activity, and Weight-Related Outcomes among University Students: A Systematic Review of Systematic Reviews
Belogianni, K., & Baldwin, C. (2019) · Advances in Nutrition · doi:10.1093/advances/nmz027 · Cited by 53
“A similar decision rule has been used in other overviews (19).”
Method
Payment 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
Self-citation
Evidence of the Potential Effectiveness of Centre-Based Childcare Policies and Practices on Child Diet and Physical Activity: Consolidating Evidence from Systematic Reviews of Intervention Trials and Observational Studies
Stacey, 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
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
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
A KT intervention including the evidence alert system to improve clinician’s evidence-based practice behavior—a cluster randomized controlled trial
Campbell, L., Novak, I., McIntyre, S. J., & Lord, S. J. (2013) · Implementation Science · doi:10.1186/1748-5908-8-132 · Cited by 47
“Our chosen measurement instrument (GAS) was sensitive to change [56,57] and appeared accurate as self- and peer-”
Method
Patient-Reported Outcome Measures as an Intervention: A Comprehensive Overview of Systematic Reviews on the Effects of Feedback
Wittich, 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
Increasing chlamydia screening tests in general practice: a modified Zelen prospective Cluster Randomised Controlled Trial evaluating a complex intervention based on the Theory of Planned Behaviour
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
Plastic Surgery or Primary Care? Altruistic Preferences and Expected Specialty Choice of U.S. Medical Students
Li, J. (2018) · Journal of Health Economics · doi:10.1016/j.jhealeco.2018.09.005 · Cited by 44
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
Exempting dissenting patients from pay for performance schemes: retrospective analysis of exception reporting in the UK Quality and Outcomes Framework
Doran, T., Kontopantelis, E., Fullwood, C., Lester, H. E., Valderas, J. M., & Campbell, S. (2012) · BMJ · doi:10.1136/bmj.e2405 · Cited by 43
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
Is the evidence on the effectiveness of pay for performance schemes in healthcare changing? Evidence from a meta-regression analysis
Zaresani, A., & Scott, A. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06118-8 · Cited by 43
Self-citation
The 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
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
“…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…”
BackgroundMethod
Performance-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
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
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
Feasibility and acceptability of two incentive-based implementation strategies for mental health therapists implementing cognitive-behavioral therapy: a pilot study to inform a randomized controlled trial
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 43
“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].”
Background
What drives general practitioners in the UK to improve the quality of care? A systematic literature review
Ahmed, 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
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
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 42
Quality of antenatal and childbirth care in rural health facilities in Burkina Faso, Ghana and Tanzania: an intervention study
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
“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…”
Background
Removing very low-performing therapists: A simulation of performance-based retention in psychotherapy.
Imel, Z. E., Sheng, E., Baldwin, S. A., & Atkins, D. C. (2015) · Psychotherapy · doi:10.1037/pst0000023 · Cited by 37
“, Zhang, F., & Soumerai, S. B. (2011). Effect of pay for perfor-”
Effect of incentive payments on chronic disease management and health services use in British Columbia, Canada: Interrupted time series analysis.
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
Impact of the introduction and withdrawal of financial incentives on the delivery of alcohol screening and brief advice in English primary health care: an interrupted time–series analysis
O'Donnell, A. J., Angus, C., Hanratty, B., Hamilton, F. L., Petersen, I., & Kaner, E. (2019) · Addiction · doi:10.1111/add.14778 · Cited by 36
“However, evidence of their impact on the quality and efficiency of healthcare remains inconclusive, particularly where long-term patient outcomes are concerned (20-23).”
Background
The 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
The conceptual framework and assessment methodology for the systematic reviews of community-based interventions for the prevention and control of infectious diseases of poverty
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
Does Winning a Pay‐for‐Performance Bonus Improve Subsequent Quality Performance? Evidence from the Hospital Quality Incentive Demonstration
Ryan, A. M., Sutton, M., & Doran, T. (2013) · Health Services Research · doi:10.1111/1475-6773.12097 · Cited by 36
“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)
ORCID: Flodgren, Gerd
Shepperd, Sasha
Scott, Anthony
Parmelli, Elena
Beyer, Fiona R
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
DOI: 10.1002/14651858.cd009255
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 › Medicine › Family Practice › 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 ›

Are you an author, or do you see a problem with this page? Request a review

An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes

Abstract

Overview

Integrity signals

Verification

Claims the paper makes

Claims other papers make about this one

Self-check

Citations

Cites

Cited by

Related

Metadata

Record

About these checks