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The Effect of Pay-for-Performance Compensation Model Implementation on Vaccination Rate

A Systematic Review

Benabbas, Roshanak MD; Shan, Gururaj MD; Akindutire, Olumide MD; Mehta, Ninfa MD; Sinert, Richard DO

doi: 10.1097/QMH.0000000000000219
Literature Review

Background and objectives: Pay-for-performance (P4P) is broadly defined as financial incentives to providers for attaining prespecified quality outcomes. Providers, payers, and public officials have worked over the years to develop innovative solutions to rapidly and consistently bring new diagnostic tests and therapies to our patients. P4P has been instituted in various forms over the last 30 years. Vaccines are one of society's greatest public health innovations and vaccination programs provide a unique opportunity for P4P programs. We attempted to investigate the effect of P4P compensation model implementation on the vaccination rate.

Methods: Utilizing a systematic review and meta-analysis approach, we searched PubMed, Embase, Scopus, and Web of Science from inception to December 2018.

Results: Nine articles were included with poor to moderate quality. Improvements in vaccination rates after implementation of P4P were statistically significant in 8 of 9 of studies. However, due to the heterogeneity of the methods used, we could not pool the data.

Conclusion: The results of this systematic review indicate that the implementation of P4P programs can increase the vaccination rate. In recent times when it has become increasingly more popular not to vaccinate, implementing P4P becomes even more important if it is shown to be an effective tool in increasing vaccination rates.

Department of Emergency Medicine, State University of New York Downstate Medical Center, and Department of Emergency Medicine, Kings County Hospital Center, Brooklyn, New York.

Correspondence: Roshanak Benabbas, MD, Department of Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn, NY 11203 (

The authors would like to thank Mr Christopher Stewart, a senior librarian at the State University of New York Downstate Medical Center, for his help in formulating the literature search strategy.

All authors certify that they have participated adequately in the work to take responsibility for the content. All authors participated in the generating the research concept, design, analysis, and writing of the article.

The authors declare no conflicts of interest.

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