title: The impact of reimbursement systems on equity in access and quality of primary care: A systematic literature review.
abstract: Reimbursement systems provide incentives to health care providers and may drive physician behaviour. This review assesses the impact of reimbursement system on socioeconomic and racial inequalities in access, utilization and quality of primary care.
  
  
  
  A systematic search was performed in Web of Science and PubMed for English language studies published between 1980 and 2013, supplemented by reference tracking. Articles were selected based on inclusion criteria, and data extraction and critical appraisal were performed by two authors independently. Data were synthesized in a narrative manner and categorized according to study outcome and reimbursement system.
  
  
  
  Twenty seven articles, mostly from the United States and United Kingdom, were included in the data synthesis. Reimbursement systems seem to have limited effect on socioeconomic and racial inequity in access, utilization and quality of primary care. Capitation might have a more beneficial impact on inequity in access to primary care and number of ambulatory care sensitive admissions than fee-for-service, but did worse in patient satisfaction. Pay-for-performance had little or no impact on socioeconomic and racial inequity in the management of diabetes, cardiovascular diseases, chronic obstructive pulmonary disease, and preventive services.
  
  
  
  We found little scientific evidence supporting an association between reimbursement system and socioeconomic or racial inequity in access, utilization and quality of primary care. Overall, few studies addressed this research question, and heterogeneity in context and outcomes complicates comparisons across studies. Further empirical studies are warranted.
authors.affiliation: Centre for Epidemiology and Community Medicine, Stockholm County Council Health Services, Stockholm, Sweden. wenjing.tao@ki.se.|Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. wenjing.tao@ki.se.
authors.forename: Wenjing
authors.initials: W
authors.lastname: Tao
authors.affiliation: Centre for Epidemiology and Community Medicine, Stockholm County Council Health Services, Stockholm, Sweden.|Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Janne
authors.initials: J
authors.lastname: Agerholm
authors.affiliation: Centre for Epidemiology and Community Medicine, Stockholm County Council Health Services, Stockholm, Sweden.|Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Burström
mesh_terms: D000553:Ambulatory Care / Q000191:economics / Q000592:standards; D018588:Fee-for-Service Plans; D000069576:Health Equity / Q000191:economics / Q000592:standards; D006297:Health Services Accessibility / Q000191:economics / Q000592:standards*; D054625:Healthcare Disparities / Q000191:economics*; D006760:Hospitalization; D006801:Humans; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000191:economics / Q000592:standards*; D012052:Reimbursement, Incentive / Q000191:economics*; D006113:United Kingdom; D014481:United States
keywords: Capitation fee; Ethnic groups; Health policy; Health services accessibility; Healthcare disparities; Inequality; Outcome assessment; Quality of health care; Reimbursement mechanisms; Socioeconomic factors