TY - JOUR T1 - Can We Expect Results-Based Financing to Improve Quality of Care? JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT SP - 1 LP - 3 DO - 10.9745/GHSP-D-17-00069 VL - 5 IS - 1 A2 - , Y1 - 2017/03/24 UR - http://www.ghspjournal.org/content/5/1/1.abstract N2 - Performance-based incentives as currently employed appear poorly adapted for improving quality of clinical processes. They mainly measure structural items that, while easier to measure, are remote from actual clinical quality, and they could even perversely lead to heightened attention to those factors at the expense of clinical quality.See related article by Gergen.Results-based financing (RBF) schemes in health care are premised on the notion that “paying for results” rather than for inputs is more likely to improve performance. But getting from that attractive hypothesis to program efforts that improve quality of care and outcomes at population scale—in the real world—is far from simple.The article by Gergen1 in this issue of GHSP offers an overview of a set of RBF schemes, mainly funded under the World Bank's Health Results Innovation Trust Fund (HRITF). Under this funding, performance-based incentives are paid to health workers and health facilities, with the intention of improving quality of health services for women and children. As of late 2016, this major funding program, supported primarily by the governments of Norway and the United Kingdom, has provided close to US$400 million in grants and more than US$2 billion in associated loans to RBF programs in 29 countries.2Incentives, as used in these schemes, get health worker attention but may not direct attention where it's most needed. As the Gergen paper acknowledges, in these financing schemes quality is operationalized largely in terms of structure, rather than processes or outcomes of care (using the language of the Donabedian model3). Among the 54 most common indicators tracked by the checklists used in the schemes Gergen et al. … ER -