Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
J Evid Based Med. 2009 May;2(2):70-83. doi: 10.1111/j.1756-5391.2009.01020.x.
Results-based financing and pay-for-performance refer to the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target. Results-based financing is widely advocated for achieving health goals, including the Millennium Development Goals.
We undertook an overview of systematic reviews of the effectiveness of RBF. We searched the Cochrane Library, EMBASE, and MEDLINE (up to August 2007). We also searched for related articles in PubMed, checked the reference lists of retrieved articles, and contacted key informants. We included reviews with a methods section that addressed the effects of any results-based financing in the health sector targeted at patients, providers, organizations, or governments. We summarized the characteristics and findings of each review using a structured format.
We found 12 systematic reviews that met our inclusion criteria. Based on the findings of these reviews, financial incentives targeting recipients of health care and individual healthcare professionals are effective in the short run for simple and distinct, well-defined behavioral goals. There is less evidence that financial incentives can sustain long-term changes. Conditional cash transfers to poor and disadvantaged groups in Latin America are effective at increasing the uptake of some preventive services. There is otherwise very limited evidence of the effects of results-based financing in low- or middle-income countries. Results-based financing can have undesirable effects, including motivating unintended behaviors, distortions (ignoring important tasks that are not rewarded with incentives), gaming (improving or cheating on reporting rather than improving performance), widening the resource gap between rich and poor, and dependency on financial incentives.
There is limited evidence of the effectiveness of results-based financing and almost no evidence of the cost-effectiveness of results-based financing. Based on the available evidence and likely mechanisms through which financial incentives work, they are more likely to influence discrete individual behaviors in the short run and less likely to create sustained changes.
基于成果的融资和按绩效付费是指根据可衡量的行动或达到预定绩效目标来转移资金或物质商品。基于成果的融资被广泛倡导用于实现健康目标，包括千年发展目标。
我们对基于成果的融资的有效性进行了系统评价综述。我们检索了 Cochrane 图书馆、EMBASE 和 MEDLINE（截至 2007 年 8 月）。我们还在 PubMed 中搜索了相关文章，检查了检索到的文章的参考文献，并联系了关键信息提供者。我们纳入了方法部分涉及针对患者、提供者、组织或政府的任何基于成果的融资对卫生部门的影响的综述。我们使用结构化格式总结了每篇综述的特点和发现。
我们发现了 12 篇符合纳入标准的系统评价。基于这些综述的结果，针对卫生保健接受者和个别医疗保健专业人员的财务激励在短期内对于简单和明确、定义明确的行为目标是有效的。几乎没有证据表明财务激励可以维持长期变化。向拉丁美洲的贫困和弱势群体提供有条件现金转移可以有效地增加一些预防服务的采用。否则，在低收入和中等收入国家中，基于成果的融资的效果的证据非常有限。基于成果的融资可能会产生不良影响，包括激励非预期行为、扭曲（忽略未因激励而获得奖励的重要任务）、博弈（改善或欺骗报告而不是改善绩效）、扩大贫富之间的资源差距以及对财务激励的依赖。
基于成果的融资的有效性的证据有限，几乎没有证据表明基于成果的融资的成本效益。根据现有证据和财务激励可能起作用的机制，它们更有可能在短期内影响离散的个人行为，而不太可能产生持续的变化。
