Outcome: objective measures of provider behaviour, such as proportion of patients treated in accordance with guidelines.
Health managers must ensure quality services, a functioning regulatory mechanism, and monitoring of provider behaviour.
There are several theories of provider behaviour that predict incentives and supply responses to payment methods.
The significant correlations found in these aspects of provider behaviour and patients' overall satisfaction are consistent with the literature on patient satisfaction.
Models of provider behaviour can be used as a supplement; Brugha and Zwi [ 64], for example, outline considerations regarding national context; needs, expectations, and social environment; provider knowledge and attitudes; and patient-provider interactions as well as potential KT interventions at the community and policy levels.
While many papers have been published discussing the theoretical effects of provider payment on provider behaviour, practical evidence is lacking to a large extent.
Yet none of the 32 articles included in our review discussed the anticipated effects of the chosen payment methods on provider behaviour, nor the policy objective in choosing a particular method.
One stream of QI research is concerned with evaluating the effectiveness of these interventions to provider behaviour and organisation (changes to providers, rather than changes to patient treatment), and with the variety of research methods which could be used.
Explanations for these disappointing results include the difficulty of changing providers behaviour and existing practices, non-optimal intervention strategies, inadequate resources devoted to evaluating the impact of interventions, and inadequate methods to design and evaluate interventions [ 13– 15].
An assessment of health provider behaviour and governance is an important strand of the evaluation of health financing schemes 46 but was outside the remit of our study.
