Analyzing hospital behavior across different payment mechanism as a response to financial incentives – a scoping review

BACKGROUND: This scoping review maps published evidence on financial incentives linked to hospital payment mechanisms and on the hospital-behavior endpoint categories examined in the literature. It provides an evidence map for subsequent systematic review work within the FLASH project, rather than estimating the direction or magnitude of effects. METHODS: The review was reported in accordance with PRISMA guidelines. Authors searched PubMed and Cochrane for English-language records published between January 2013 to February 2023. Data was independently screened and extracted by two authors. In total, 140 full-text records were included and classified country, publication year, payment mechanism, financial-incentive category, and endpoint category. RESULTS: Since 2015, the number of publications on financial incentives in healthcare has generally increased. Most included publications covered changes in the United States, Taiwan, China, and the United Kingdom. The identified incentives were mapped within payment-mechanism categories, including Activity-Based Payment, Incremental, Consolidated, and Budget mechanisms, following WHO/OECD and Urban Institute classifications. Activity-Based Payment was the most frequently studied category; the endpoint categories most often examined in this group were efficiency of spending funds (42 publications), access (27 publications), and hospitals' finances (22 publications). Studies of incremental mechanisms, mainly Pay-for-Performance (P4P), most often examined quality (41 publications) and efficiency of spending funds (24 publications), while consolidated mechanisms were represented less frequently across endpoint categories. These counts describe the distribution of the literature and do not indicate effect direction, magnitude, or statistical significance. CONCLUSIONS: The review identifies where evidence on hospital payment mechanisms, financial incentives, and hospital-behavior endpoint categories is concentrated and where gaps remain. The most researched endpoint categories are linked to efficiency of spending funds, quality, access, and hospital finances. Payer spending and budget-based mechanisms are comparatively less represented. We identify priorities for subsequent systematic review and for a database that extracts the direction, magnitude, and context of reported effects.