title: Impact of pay for performance on behavior of primary care physicians and patient outcomes.
abstract: OBJECTIVE
  Pay-for-performance is a financial incentive which links physicians' income to the quality of their services. Although pay-for-performance is suggested to be an effective payment method in many pilot countries (ie the UK) and enjoys a wide application in primary health care, researches on it are yet to reach an agreement. Thus, a systematic review was conducted on the evidence of impact of pay-for-performance on behavior of primary care physicians and patient outcomes aiming to provide a comprehensive and objective evaluation of pay-for-performance for decision-makers.
  
  
  METHODS
  Studies were identified by searching PubMed, EMbase, and The Cochrane Library. Electronic search was conducted in the fourth week of January 2013. As the included studies had significant clinical heterogeneity, a descriptive analysis was conducted. Quality Index was adopted for quality assessment of evidences.
  
  
  RESULTS
  Database searches yielded 651 candidate articles, of which 44 studies fulfilled the inclusion criteria. An overall positive effect was found on the management of disease, which varied in accordance with the baseline medical quality and the practice size. Meanwhile, it could bring about new problems regarding the inequity, patients' dissatisfaction and increasing medical cost.
  
  
  CONCLUSIONS
  Decision-makers should consider the baseline conditions of medical quality and the practice size before new medical policies are enacted. Furthermore, most studies are retrospective and observational with high level of heterogeneity though, the descriptive analysis is still of significance.
authors.affiliation: West China School of Medicine/West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Yifei
authors.initials: Y
authors.lastname: Lin
authors.affiliation: West China School of Medicine/West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Senlin
authors.initials: S
authors.lastname: Yin
authors.affiliation: West China School of Medicine/West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Huang
authors.affiliation: Periodical Press of West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Du
keywords: Patient outcomes; Primary care; pay-for-performance; physicians; systematic review