2021-06-10-世界卫生组织-Performance_incentives_for_health_in_high-income_countries_key_issues_and_lessons_learned_46页_1mb

Performance incentives for health in high-income countries are explored in this World Health Organization background paper, focusing on schemes like Pay-for-Performance (P4P), Results-Based Financing, and Performance-Based Contracting. These schemes aim to improve health outcomes by linking financial rewards or sanctions to specific provider behaviors or results, but their implementation varies widely. The paper is based on the 2010 World Health Report and draws from examples in countries like the US, UK, Australia, Spain, and Italy.

Key issues identified include the diversity of incentive structures, the challenge of targeting individual versus organizational levels, focus on quantity versus quality of care, cost implications, selection of performance indicators, and potential negative effects such as gaming the system. Most schemes emphasize quality in high-income settings due to structural incentives favoring volume, while in low-income contexts, they often aim to increase service utilization.

Lessons learned highlight the need for context-sensitive design, clear translation of incentives to staff, evidence-based indicator choices, and optional use of competition versus individual rewards. The analysis shows that while schemes can improve performance, they often face low financial impact, the risk of unintended consequences like staff demotivation or gaming, and limited robust evidence due to context-specific implementation.

The paper concludes that performance incentives are a growing approach with potential benefits, but their success depends on careful architecture and contextual adaptation. High-income country experiences provide insights, but generalizability to low-income settings is limited because incentives address different problems in different contexts. Further research is needed to build on these findings and develop more effective, evidence-based schemes.