Guest editorial: Payment for performance: comparing policy making, design and implementation in health, social care and education

• Date: 05 December 2023
• Pages: 481-491
• DOI: https://doi.org/10.1108/IJPSM-10-2023-355
• Published date: 05 December 2023
• Subject Matter: Public policy & environmental management,Politics,Public adminstration & management
• Author: Fabiana da Cunha Saddi,Stephen Peckham,Garrett Wallace Brown,Dimitri Renmans,Allan Nuno Alves de Sousa

Guest editorial: Payment

for performance: comparing

policy making, design

and implementation in health,

social care and education

Over the last four decades payment for performance (P4P), also known as performance-based

financing (PBF) or results-based financing (RBF), has been increasingly applied in a variety

of contexts (and sectors) with the expectation that it can improve the performance of health

systems in low- and middle-income countries (LMICs) and high-income countries (HICs).

Initially adopted as a method for improving health worker and health organisation

performance, P4P/PBF has been increasingly seen as a mechanism for more strategic reform

of health systems (especially in LMICs).

P4P has its roots in private sector management and is based on the use of financial

incentives to extrinsically motivate workers to improve their performance and thus improve

organisational performance. In the 1970s and 1980s, such initiatives were introduced in

public sector organisations as New Public Management (NPM) concepts and started to

become embedded in public administrations (Pollitt, 1993). However, it is important,

especially in the context of the papers presented in this special edition, to note the difference

between NPM as a concept or ideology and PBF modalities as management practices that are

associated with NPM but are not necessarily predicated on the adoption of NPM as an

ideological approach.

As reported by other papers published in this journal over the past decades (Dixon, 2021;

Hur, 2018), the application of pay for performance staff reward schemes within public sector

became widespread internationally. However, the practice also spread into team and

organisational performance related payments. Aoki (2019) demonstrated the widespread use

of performance related pay in education services across 60 countries world-wide finding that

such policies were, in 2012, most widely used in less accountable and less wealthy economies.

In global health financing, it has been suggested that PBF experienced a similar phenomenon,

where generalised programmes acted as “travelling models”with major international

organizations promoting similarly designed schemes across different country contexts

(Olivier de Sardan et al., 2017;Paul and Ridde, 2022). This was particularly the case in LMICs,

with a limited evidence-base nor space for adaptation (Barnes et al., 2015). The research by

Aoki further highlighted an important “wave effect”and that results often demonstrated a

situation where early adopters had already ended schemes, suggesting that there have not

been many “lessons learned”from previous programmes. For example, by the 1990s, there

were already concerns being expressed about both the efficacy of such programmes in the

private sector and their potential for adoption in the public sector (Ingraham, 1993). By the

2000s, several scholars were also suggesting the end of NPM type approaches in the public

sector with the emergence of new concepts of public governance (Dunleavy et al., 2006;

Osborne, 2006).

In public health, P4P programmes can be broadly defined as a mechanism through which

health providers can be partially financed and/or health professionals receive financial

incentives based on their performance when measured against predetermined indicators/

targets (Saddi et al., 2018). Over the last two decades, not only did P4P types of programmes

Guest editorial

481

International Journal of Public

Sector Management

Vol. 36 No. 6/7, 2023

pp. 481-491

© Emerald Publishing Limited

0951-3558

DOI 10.1108/IJPSM-10-2023-355