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<p>The global shift towards Universal Health Coverage has amplified the pressure on healthcare systems to achieve high-quality outcomes while containing rising costs. Outcome-based models (OBMs), which link payments to results rather than service volume, are increasingly seen as a promising solution. Yet, their implementation remains complex, and there is limited guidance on how to operationalize OBMs effectively in real-world settings. This paper presents a Scoping Review (SR), guided by the PRISMA-ScR methodology, analyzing 34 studies to address three core questions: (1) How have OBMs been applied in healthcare? (2) What typologies of OBMs exist? (3) What are the key components that enable successful OBM design and implementation? The review identifies nine OBM types, from basic reward-penalty contracts to more advanced models such as milestone-based annuities and population-based pricing. Common challenges include stakeholder misalignment, data governance constraints, and difficulties in risk-sharing. Crucially, the study consolidates insights into a practitioner-oriented conceptual framework that highlights the actionable building blocks of effective OBM design—such as contract negotiation strategies, performance metric validation, robust data infrastructure, and iterative implementation pathways. For practitioners, this review provides clear guidance on aligning incentives with stakeholder capabilities, scoping OBMs for local feasibility, and utilising pilot projects to mitigate risks associated with broader rollouts. The framework serves as a guideline to support decision-makers in adapting OBMs to their specific health system context, with consideration of both accountability and sustainability. The paper concludes by suggesting further practice-based research, particularly in underrepresented regions like Africa, to strengthen the evidence base and inform context-sensitive OBM adoption strategies.</p>

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Designing and implementing outcome-based models in healthcare: insights and strategies from a scoping review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月26日

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  • Grace T. Chidavaenzi,
  • Faatiema Salie,
  • Sara S. Grobbelaar

摘要

The global shift towards Universal Health Coverage has amplified the pressure on healthcare systems to achieve high-quality outcomes while containing rising costs. Outcome-based models (OBMs), which link payments to results rather than service volume, are increasingly seen as a promising solution. Yet, their implementation remains complex, and there is limited guidance on how to operationalize OBMs effectively in real-world settings. This paper presents a Scoping Review (SR), guided by the PRISMA-ScR methodology, analyzing 34 studies to address three core questions: (1) How have OBMs been applied in healthcare? (2) What typologies of OBMs exist? (3) What are the key components that enable successful OBM design and implementation? The review identifies nine OBM types, from basic reward-penalty contracts to more advanced models such as milestone-based annuities and population-based pricing. Common challenges include stakeholder misalignment, data governance constraints, and difficulties in risk-sharing. Crucially, the study consolidates insights into a practitioner-oriented conceptual framework that highlights the actionable building blocks of effective OBM design—such as contract negotiation strategies, performance metric validation, robust data infrastructure, and iterative implementation pathways. For practitioners, this review provides clear guidance on aligning incentives with stakeholder capabilities, scoping OBMs for local feasibility, and utilising pilot projects to mitigate risks associated with broader rollouts. The framework serves as a guideline to support decision-makers in adapting OBMs to their specific health system context, with consideration of both accountability and sustainability. The paper concludes by suggesting further practice-based research, particularly in underrepresented regions like Africa, to strengthen the evidence base and inform context-sensitive OBM adoption strategies.