Mapping barriers and facilitators to healthcare provider payment reform

BACKGROUND: Health care systems are constantly evolving to better meet changing health needs and to adapt to external pressures. Reforms are therefore an integral part of health systems. One of the most common reforms concerns provider payment systems, including changes to payment methods. These are considered one of the most important levers through which policymakers can influence the performance of health system. The objective of this study was to identify, systemize and map the factors (barriers and facilitators) that influence provider payment reforms around the world. METHODS: A scoping literature review was conducted. The study followed the relevant methodological guidelines and the PRISMA-ScR checklist. The authors systematically searched the literature in five databases and manually in relevant organisations and journals. Studies published in English since 2000 were included. Data on factors influencing payment reform were analysed thematically using inductive approach. RESULTS: The study included 51 publications, mostly from developed countries (n = 36). The most commonly changed payment method was fee-for-service (72%, n = 37). The study identified 43 sub-themes on barriers (grouped into eight major themes) and 51 sub-themes on facilitators (grouped into six major themes). Barriers include stakeholder opposition, challenges related to reform design, hurdles in implementation structures, insufficient resources, challenges related to market structure, legal barriers, knowledge and information gaps, and negative publicity. Facilitating factors include stakeholder involvement, complementary policies, relevant prior experience, good leadership and management of change, sufficient resources, and external pressure to introduce the reform. CONCLUSIONS: Factors influencing payment system reform are often interrelated, contextual, and represent a variety of perspectives, including those of patients, providers, insurers, and policymakers. KEY MESSAGES: • The same factor can act as a barrier or facilitator to provider payment reform, depending on the context. • When planning payment reform, policymakers should anticipate the potential barriers and plan appropriate facilitating measures.