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A vast amount of literature on effects of pay-for-performance (P4P) in health care has been published. However, the evidence has become fragmented and it has become challenging to grasp the information included in it.

To provide a comprehensive overview of effects of P4P in a broad sense by synthesizing findings from published systematic reviews.

Systematic literature search in five electronic databases for English, Spanish, and German language literature published between January 2000 and June 2011, supplemented by reference tracking and Internet searches. Two authors independently reviewed all titles, assessed articles’ eligibility for inclusion, determined a methodological quality score for each included article, and extracted relevant data.

Twenty-two reviews contain evidence on a wide variety of effects. Findings suggest that P4P can potentially be (cost-)effective …