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Pay-for-performance: Time to act but also to provide further evidence
|Journal||Health Policy 120(10);
Around 25 years ago, the idea to pay for achieving targets, pay for quality or “pay for performance” (P4P), as it is nowadays usually referred to, was first advocated and applied. While the idea to pay for evidence-based processes, intermediate outcomes (such as immunization rates) or actual health outcomes, rather than for “being-there” (typically by budgets for institutions or salaries for health professionals) or providing all kinds of services (exemplified by fee-for-service payments) appears intriguing and has a lot of face value, it is still debated controversially until today, even while more and more countries have started to use P4P in various forms. The main issues in this debate are whether the available evidence is strong enough to support a more widespread introduction of P4P at all, and if yes, how such programmes should look like, e.g. in regard to whether they award institutions or individuals, whether the award is paid as a bonus or a malus/penalty, whether the achievement is based on absolute or relative measures, or how large the incentive has to be in order to achieve the desired results.