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Purchasing primary care services for quality chronic care: Capitation with performance payments in four countries - P4H Network

Purchasing primary care services for quality chronic care: Capitation with performance payments in four countries

Published in The International Journal of Health Planning and Management, the open-access short communication “Purchasing Primary Care Services for Quality Chronic Care: Capitation With Performance Payments in Four Countries” examines how provider payment reforms can enhance chronic care quality in low- and middle-income settings. Authored by a multi-country team of experts, the study analyses case studies from Chile, China, Indonesia, and South Africa—countries that introduced capitation payments combined with performance-based incentives to improve service delivery for non-communicable diseases (NCDs).

While these reforms aimed to boost provider accountability and patient outcomes, the findings reveal that financial incentives alone were insufficient to drive meaningful change. Implementation challenges, such as voluntary enrolment, quality metric selection, risk adjustment, and payment uncertainty—limited the effectiveness and uptake of these programs. The article underscores the need for more nuanced policy design, including progressive performance targets and consistent payment mechanisms, to avoid penalising providers and to ensure equitable improvements in chronic care delivery.

Reference
Sarah L. Barber, Inke Mathauer, Megumi Rosenberg, Nicolas Larrain, Yunguo Liu, Qian Long, Anja Smith, Stevie Ardianto Nappoe, Luca Lorenzoni, Purchasing primary care services for quality chronic care: Capitation with performance payments in four countries, The International Journal of Health Planning and Management, 08 Apr 2025