Pay for performance (P4P) is increasingly used to improve efficiency and service quality in health systems but evidence is limited that it increases value for money, boosts quality of processes in health care, or improves health outcomes.

This book uses 12 case studies from P4P programmes in OECD countries to explore the many questions surrounding the design and implementation of P4P programs and examines the supporting systems and process, in addition to incentives, that are necessary to drive and sustain performance improvement.

To download this study from the European Observatory, click here on