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Drawing on the pay-for-performance (P4P) and job satisfaction literatures through an analysis of qualitative studies published on the topic, the purpose of this study is to investigate the effect of a P4P-based system on job satisfaction and dissatisfaction among health care workers.

A meta-synthesis of the qualitative literature was conducted to investigate health care workers' opinions, perceptions and behaviors and fully understand what processes generate job satisfaction or dissatisfaction under P4P systems.

The findings suggest that P4P systems impact the job (dis-)satisfaction of health care workers based on the institutional, organizational, geographic and cultural context of reference. Specifically, job satisfaction – and thus motivation, occupational well-being and work engagement – can occur when the context is supportive, whereas job dissatisfaction – and thus work stress and pressure, burnout and work-life balance issues and distraction – is generated in the case of unsupportive contexts. Moreover, the findings suggest a virtuous/vicious circle whereby job satisfaction leads to positive performance and further fuels job satisfaction, while conversely job dissatisfaction generates worse performance, and this further worsens worker satisfaction.

There is a lack of studies comparing and analyzing current evidence on the job (dis-)satisfaction of health care workers operating in different contexts based on the reward system. This is the first research to analyze a significant number of studies with reference to the relation between P4P and job (dis-)satisfaction, which are topics in need of further study and investigation in health care settings around the world.

The use of pay for performance (P4P) as an instrument to incentivise quality improvements in health care is at a crossroads in high-income countries but has remained a commonly used tool in low- and middle-income countries. The authors aimed to take stock of the evidence on effectiveness and design from across income settings to reveal insights for the future design of performance payment across income contexts.

The authors identified Cochrane literature reviews of the use of P4P in health care in any income setting, tracked the development in the quantity and quality of evidence over time, and compared the incentive design features used across high-income countries compared to low- and middle-income countries.

The quantity and quality of the evidence base have grown over time but can still be improved. Scheme design varies across income settings, and although some design choices may reflect differences in context, the authors find that incentive designers in both income settings can learn from practices used in the other setting.

The research and literature on P4P in high-, low- and middle-income countries largely operate in silos. By taking stock of the evidence on P4P from across income settings, the authors are able to draw out key insights between these settings, which remain underexplored in the literature.

In 2011, Brazil introduced a national pay-for-performance (P4P) scheme called the National Program for Improving Primary Health Care Access and Quality (PMAQ), rolled out over three cycles and reaching more than 5,000 municipalities and 40,000 family health teams (FHTs). There is little evidence on how the PMAQ was implemented locally and whether this variation in implementation affects performance, particularly, in terms of work process indicators. This study compared different cases of municipal-level PMAQ implementation (bonuses paid or not to FHTs) over the last two program cycles to analyze the quality of the work processes, actions and services of FHTs.

This was a cross-sectional analytical study using secondary data from an external evaluation of the Brazilian PMAQ. In total, 27,500 FHTs participated in the evaluation. They were divided into four clusters based on whether or not municipalities paid bonuses to workers during cycles 2 and 3 of the program (2013–2019). Variables regarding work processes, actions and services were classified as “Quality Assurance – QA” or “Continued Quality Improvement – CQI”, and an individual score was assigned based on the average score of each variable.

The four clusters displayed an increase in overall QA and CQI scores between the two program cycles; though this increase was small between the set of primary health care teams that received bonuses and those that did not.

This paper contributes to bridging the gap in the scientific literature for evaluative studies on the relationship between direct payment for performance to health professionals and better quality actions and services in low and middle-income countries.

Pay-for-performance (P4P) as an innovation for improved health care has been introduced in many health systems worldwide. The aim of this article is to apply and refine a specific theoretical angle for the analysis of these reforms, the theoretical frameworks of public policy instruments and programmatic actors, in order to highlight differences between countries.

This analysis is based on a comparative case study of the introduction of P4P in France and Germany in the ambulatory sector for the period from 2007 until 2017. This included a literature review and semi-structured interviews with 23 actors between 2013 and 2015.

The introduction of a supposedly clear-cut policy instrument – P4P in health care – is distinctly shaped by the intertwined configuration of institutional architecture and the policy programme of key system actors. This can be understood as a continuation of long-term transformations, most importantly the increasingly direct influence of the state and a weakening of the representation of the medical profession, as well as an internal fragmentation of the latter.

This analysis illustrates the applicability of the policy instrument approach to the heath sector. In addition, the authors have applied the dual perspective of policy instruments and programmatic actors. Both proved complementary and appropriate for the study of a highly technical instrument such as P4P.

This qualitative narrative review aims to identify and evaluate the potential, challenges and pitfalls of pay-for-performance (P4P) schemes for the home care of adults with a disability. Due to a limited experimentation with P4P schemes in the context of the home and disability care sectors, the authors conducted a narrative review focusing on related areas of care, primarily nursing home care, to better understand the effectiveness of P4P schemes as a care intervention and evaluate the challenges associated with the introduction of these schemes.

The authors employed a narrative review approach to examine the effectiveness of P4P schemes as a care intervention. The approach included a manual content analysis of the relevant academic and grey literature, focusing on the potential, challenges and pitfalls of P4P for care funders and providers.

There is some, albeit limited, evidence from other related areas of care to support the effectiveness of P4P to improve the quality of care or the efficiency of its delivery for the home care sector. The results of prior studies are, however, often mixed and inconclusive, due to flaws with the design of schemes, including the nature of the incentives. Limited duration and poor-quality evaluations have further hampered the ability of studies to demonstrate the effectiveness of P4P schemes, which diminishes the credibility of these care interventions. When undertaken systematically, there seems to be some evidence that P4P can work; however, it requires careful design, implementation, measurement and evaluation.

Based on the challenges associated with the successful implementation of P4P schemes, the authors identified lessons for the design, implementation, measurement and evaluation of P4P schemes for care funders and policymakers.

This study critically evaluates the potential of P4P as a care intervention for the home care and disability sectors. By evaluating the potential, challenges and pitfalls associated with P4P in related areas of care, the study provides guidance to home care funders, providers and policymakers in care settings.

This paper aims to analyze the development of “pay‐for‐performance” (P4P) programs implemented by Israel's two largest sick funds, insuring 78 percent of the population.

Analysis of the main features and their evolution over time, the observed outcomes and concerns related to implementing these programs.

Our analysis revealed that although implementation has been successful, both managers and physicians have voiced concerns regarding the effect of measuring clinical performance such as focusing attention on the measured areas while neglecting other areas, and motivating a statistical approach to patient care instead of providing patient‐centered care.

The Israeli case provides an interesting example of nation‐wide, long‐term implementation of the pay‐for‐performance program. Therefore, it provides other countries with the opportunity to assess features that may facilitate successful implementation, as well as highlighting issues related to the outcomes of P4P programs.

Human resources management (HRM) has evolved from primarily focusing on monetary incentives toward incorporating other nonmonetary aspects for managing professionals’ motivation. However, in health care organizations, paying professionals for performance persists although evidence for its return on investment is scant. This raises the question whether monetary incentives are, in fact, the (only) motivator for health care professionals or whether other incentives could substitute or complement them in the future. This chapter reviews the basic ideas of pay for performance (P4P) and its current challenges. Taking into account HRM's experience (and evolution) in other industries, I discuss the interdependence and the impact of extrinsic and intrinsic motivators in health care. On the basis of the health care market's standing as a knowledge-intensive industry in which multiple actors contribute their knowledge to multiple tasks, I will offer suggestions how to manage motivation based on individuals’ intrinsic needs instead of relying solely on extrinsic motivators.

New Public Management-informed pay-for-performance policies are common in public sectors internationally but can be controversial with delivery agents. More attention is needed on contingent forms of bottom-up implementation of challenging policies, in emerging market economies, for professionals who face tensions between policies and their codes of practice. Street-level bureaucrats (SLBs) mediate policy implementation through discretionary practices; health professionals have enhanced space for discretion based on autonomy derived from professional status. The authors explore policy implementation, adaptation and resistance by physicians, focusing on payments for health workers in Turkey.

The researchers conducted semi-structured qualitative interviews with 12 physicians in Turkish hospitals and thematic analysis of interview transcripts, using a blended (deductive and inductive) approach.

The policy fostered discretionary behaviours such as cherry-picking (high volume, low risk procedures) and pro-social rule-breaking (e.g. “upcoding”), highlighting clinical autonomy to navigate within policy restrictions. Respondents described damage to relationships with patients and colleagues, and dissonance between professional practice and perverse policy incentives, sometimes leading to disengagement from clinical work. Policymakers were perceived to be detached from the realities experienced by SLBs. Tensions between the policy and professional values risked alienating physicians.

This study utilises participant self-reported perceptions of discretionary behaviours. Further work may adopt alternative methods to explore the relationship between self-reporting and observed practice.

The authors contribute to research on differentiated, contingent roles of groups with high scope for discretion in bottom-up implementation, pointing to the potential for policy-professional role conflicts between top-down P4P policies, and the values and codes of practice of professional SLBs.

This paper employs implementation theory and the political literature on performance measurement to understand how frontline health workers know, participate and evaluate the Brazilian National Program for Improving Access and Quality of Primary Care (PMAQ, 2nd round).

This paper develops an implementation theory-driven qualitative analysis. The research is developed in the city of Goiania (Brazil): a challenging organizational context in primary care (PHC). Interviews were carried out with 25 frontliners – managers, doctors, nurses and community health workers. Data were thematically and hierarchically analysed according to theoretical concepts such as policy knowledge, policy adherence, forms of accountability, alternative logics, organizational capacity and policy feedback.

Results show the need to foster organizational capacity, knowledge, participation and policy feedback at the frontline. Successful implementation would require those adaptations to counteract policy challenges/failures or the emergence of alternative logics.

The study was conducted in only one setting, however, our sample includes different types of professionals working in units with different levels of organization capacity, located in distinct HDs, expressing well the implementation of PMAQ/P4P. Qualitative researches need to be developed for further exploring the same/other factors.

Findings can be used to improve discussions/planning and design of P4P programs in the city and State of Goias.

The majority of analysis of PMAQ are of a quantitative or results-based nature. This article focuses on politically significant and unanswered questions regarding the implementation of PMAQ.