Performance-based payment models and value-based health care: a semi-systematic review through theoretical lenses.

OBJECTIVES

To identify and critically examine the theoretical lenses applied in the literature to conceptualize performance-based and value-based payment models, and to analyze how these frameworks explain their behavioral, organizational, and system-level effects.

METHODS

A semi-systematic review was conducted in July 2025 across Web of Science, PubMed/MEDLINE, Embase, LILACS, and CINAHL, using a structured search strategy and transparent selection procedures following PRISMA 2020 reporting principles. Eligible empirical and theoretical studies on value- or performance-based payment were extracted using the ADO (Antecedents, Decisions, Outcomes) framework.

RESULTS

Studies interpreted incentive effects mainly through incentive theory and principal-agent models, complemented by economics, organizational and institutional theories, implementation science, and ethics. P4P was theorized as a contractual mechanism relying on extrinsic incentives, whereas VBHC was framed as an organizational and normative paradigm requiring care redesign and longitudinal outcome-cost measurement. Theoretical extensions integrated incentive-based payment with chronic care models, disease management, activity-based costing, population health management, and the Quadruple Aim. Institutional and political economy lenses highlighted contextual contingency, while normative theories foregrounded ethical tensions, risks to professional autonomy, workforce well-being, and equity trade-offs.

CONCLUSION

Incentive-based payment reforms are not neutral technical instruments but theory-dependent and institutionally mediated interventions that require alignment with care models, governance arrangements, and ethical safeguards.

SYSTEMATIC REVIEW REGISTRATION: https://osf.io/5kv3w/, Open Science Framework (OSF), identifier 5kv3w.