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Impact of prospective payment systems: An umbrella review of systematic reviews
Mélanie Lefèvre1, Koen Van den Heede1, Carine Van de Voorde1
1Belgian Health Care Knowledge Centre (KCE), Belgium.
Background:
Prospective payment systems are widely used in OECD countries and beyond to reimburse hospital care.
Objective:
To evaluate the impact of prospective payments systems on the quality of patient care, healthcare efficiency, volume of activity, and hospital costs.
Methods:
Umbrella review by searching three electronic databases for systematic reviews with or without meta-analyses published between 2014 and July 2025. The quality of the included studies was assessed with AMSTAR 2, and tables were constructed to display the characteristics and results of the retrieved publications.
Results:
Ten systematic reviews were identified that evaluated the impact of prospective payment systems on healthcare efficiency, quality of care, volume of activity and costs. Most of the included reviews drew upon relatively recent primary studies and were of moderate to high methodological quality. Regarding efficiency, most reviews demonstrated that the implementation of prospective payment systems leads to a reduction in hospital length of stay. The umbrella review did not identify substantial evidence of a negative impact on the quality of care. The impact on healthcare costs was less consistently reported, and findings were inconclusive. The evidence on activity volume is also mixed.
Conclusions:
This review supports the theoretical assumption that prospective payment systems incentivise greater efficiency in healthcare delivery, without detrimental effects on quality of care. However, these conclusions are limited by the heterogeneity of the included payment programmes, contexts, and accompanying interventions, that make it challenging to attribute observed impacts directly to the payment system.
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