A Typology of pay-forperformance programs in publicly funded primary healthcare systems

Background: Over the last decade many systems have introduced pay-forperformance (P4P) programs in primary care with the goals of enhancing health care service delivery. The design and implementation of such programs has been fragmented across jurisdictions, and the individual resultant programs vary in nature and in nomenclature. Comparisons across these programs are challenging given the distinct lack of a standardized unifying framework. Methods: We review policy documents and conduct a systematic review of associated literature of seven pay-for-performance systems in four Commonwealth countries which seem to have similar philosophies and histories regarding publicly funded primary health care. These countries are: Australia, Canada, New Zealand and the United Kingdom. Results: We create a typology of P4P programs in primary health care in the context of public funding. Our typology identifies four key dimensions of P4P programs, each of which is further divided into categories. The dimensions are: type of service targeted, nature of target, nature of reward, and budget implications. The typology is applied to the seven case study systems to illustrate how it can facilitate comparisons between programs. Conclusions: A standardized typology of P4P program is an important first step in the gaining of a comprehensive understanding of the mechanisms underlying these programs, and their

Author(s): Wranik D,Katz A

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