This commentary argues that it is crucial to pay greater attention to the “forest”—that is, overall health system reforms and how provider payment arrangements interact with these to influence health outcomes, as opposed to looking almost solely and more narrowly at the “trees”—that is, the details and impact of a P4P mechanism divorced from the underlying health system. P4P is a category of strategic purchasing, the effectiveness of which depends critically on its connections with the wider environment of purchaser–provider relations. In the following paragraphs, we unpack the potential health system benefits of P4P. Next, we briefly outline our concerns around the current P4P debate that has too often focused on the trees (e.g., specific payment arrangements focused on boosting a few indicators) but ignoring how these fit within and are affected by the wider forest (larger health system reforms). We conclude by suggesting some ways forward as to policy framing and country reform.

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Author/s: Agnès Soucat, Elina Dale, Inke Mathauer & Joseph Kutzin
Countries: Global
Date of Publication: April 2017

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