In the past 15 years, Brazil has undergone notable social and public health changes, including a large reduction in child mortality. The Bolsa Familia Programme (BFP) is a widespread conditional cash transfer programme, launched in 2003, which transfers cash to poor households (maximum income US$70 per person a month) when they comply with conditions related to health and education. Transfers range from $18 to $175 per month, depending on the income and composition of the family.

Brazil has made significant strides in improving the organization and financing of its health system since the constitutional change establishing the right to health care in 1988. Government health financing was consolidated, the public delivery system was organized into a country-wide system (Unified Health System, or SUS), and programs such as the Basic Health Package (PAB) and Family Health Program (PSF) have shifted the focus from a hospital-heavy system to basic primary care.

This case study presents the initial results of the pay-for-performance (P4P) experience of UNIMED-Belo Horizonte (UBH), a private, nonprofit organization in Brazil. UBH is both a health insurance company and a medical cooperative operating in a highly competitive market. UBH is implementing two P4P programs: paying contracted hospitals to pursue and eventually achieve accreditation, and paying physicians to follow disease management protocols for selected conditions such as diabetes, cardiovascular disease, and childhood asthma.

This presentation tells you everything you need to know about P4P, specifically related to paying health care providers. Examples from the USA, UK, Brazil and Haiti are included, as well as:

  • Performance Incentives to Households and/or Providers
  • Paying Providers Based on Performance
  • Types of Measures
  • Different Methods to Pay Based on Performance
  • What is Financial Risk for providers under P4P?


From a World Bank-World Health Organization Strategic Purchasing Workshop in Bangkok in December 2009.

This presentation was developed and given by Jerry La Forgia (with input from Rena Eichler and Cristian Baeza) for the March 2010 Human Development Governance Workshop in Bangkok.
It includes information on design options, lessons learned, and results in performance-based intergovernmental transfers in Brazil and Argentina.
Both programs have altered the ways that health systems are functioning:

This presentation was given by Dr. Paulo Borem, Commercial Director of UNIMED/Belo Horizonte, Brazil at the Joint Learning Workshop: Moving Toward Universal Health Coverage/Incentives for Improving Quality of Care. This workshop was held in Gurgaon, India from February 2-5, 2010. It conveys the design, results, and lessons learned of a successful pay-for-hospital accreditation scheme established by UNIMED, a non-profit insurer. Hospitals are paid higher fees as they achieve “stages” of accreditation as defined by the Brazil’s, National Accreditation Organization.

This project builds upon and consolidates previously existing cash transfer programs, including Bolsa Escola (School Cash Transfer), Bolsa Alimentacao (Nutrition Cash Transfer), Cartao Alimentacao (Food Transfer Program), and Auxilio Gas (Cooking Gas compensation) into one conditional cash transfer program, Bolsa Familia (BFP), which targets the poorest families in Brazil. Brazil is one of the most inequitable societies with a Gini coefficient  of 0.59.

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