Challenges of payment-for-performance in public services – implications for health care
Mylene Lagarde and Nicholas Mays, PIRU, London School of Hygiene & Tropical Medicine
To use financial resources more efficiently and ensure the provision of adequate quantity and quality of services, public service payers have increasingly used “pay-for-performance” (P4P) mechanisms that reward individuals, teams or organisations if they achieve certain targets in the delivery of public services.
PIRU recently organised a 2-day workshop gathering academic and policy experts involved in the design, study, implementation or evaluation of Pay-for-Performance mechanisms. This presentation will present the key messages emerging from the workshop as well as recent initiatives in the health care sector. More specifically, it will present lessons in three areas:
- Design of P4P schemes: we will discuss the main choices that have to be made at the design stage (choice of payment beneficiary, performance measure, payment conditionality and payment characteristics). A typology of existing schemes in health will be presented.
- Implementation of P4P schemes: this will cover some of the issues that may arise during the implementation of P4P programmes, reflecting messages from recent research and experiences in health (P4P in hospitals in England, Drug and Alcohol pilots).
- Evaluation of P4P schemes: here, we will summarise the main findings and gaps in the evidence on P4P and reflect on the need for, and challenges involved in, carrying out evaluations of P4P.