Prospective payment system transformation (2000-2024): temporal trends, payment architecture, and cross-national...

Prospective Payment Systems (PPS) have been widely adopted over the past two decades as instruments for cost containment and efficiency improvement in health systems. However, much of the existing literature focuses on individual payment arrangements or single-country experiences, with limited attention to broader temporal, structural, and regional patterns reported across PPS-related reforms. This study examines patterns reported in the PPS-related literature published between 2000 and 2024, with particular emphasis on temporal trends, payment architecture, and regional variation in reform approaches.

This study constitutes a secondary narrative analysis of 168 studies included in a prior systematic review. No additional searches were conducted. Using an interpretive analytical framework, the included studies were synthesized across three dimensions: temporal trends reported in the literature, structural characteristics of payment architecture, and regional or country-level variation in implementation and reform patterns.

From 8,615 identified records, 168 studies met the inclusion criteria. Diagnosis-Related Groups (DRG)-based systems (32.1%) and pay-for-performance arrangements (26.2%) were the most frequently examined configurations, followed by global budget and capitation approaches (17.9%). A substantial increase in publications was observed after 2016, with 63.7% of studies published between 2016 and 2024. Across the reviewed literature, three broad periods of policy and research emphasis were identified: an earlier period focused primarily on cost standardization and inpatient expenditure control (2000-2007); a subsequent period characterized by increasing attention to hybrid arrangements and quality-linked components (2008-2015); and a more recent period emphasizing bundled payments, context-adapted designs, and integration with budgetary constraints (2016-2024). Regional variation revealed heterogeneous implementation and reform patterns across North America, Europe, and Asia.

The findings of this review suggest that PPS-related reforms are more appropriately understood as configurations of payment architecture embedded within broader institutional and governance contexts rather than as isolated payment models. Reported outcomes appear to depend less on model labels and more on design configuration and implementation capacity. Future research and policy analysis may benefit from more systematic reporting of payment architecture and its institutional prerequisites.