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All Journal International Journal of Accounting & Finance in Asia Pasific
Merlin Hatumena
Universitas Pendidikan Nasional
Decision Sciences, Operations Research & Management Economics, Econometrics & Finance

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Financial Incentive Reforms and Hospital Performance: A Systematic Review of Governance Mechanisms and Institutional Effects Merlin Hatumena; Nyoman Sri Subawa; Ida Ayu Oka Martini; Made Suidarma
International Journal of Accounting and Finance in Asia Pasific (IJAFAP) Vol 9, No 1 (2026): February 2026
Publisher : AIBPM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32535/ijafap.v9i1.4442

Abstract

Hospital payment reforms, including pay-for-performance (P4P), diagnosis-related groups (DRG), bundled payments, value-based purchasing, and hybrid incentive systems, have been widely implemented to improve hospital quality, efficiency, and accountability, although empirical findings remain inconsistent across healthcare settings. This study aims to synthesize and evaluate the effectiveness of financial incentive reforms on hospital-level performance outcomes and identify the contextual factors influencing their implementation. Using a systematic review approach based on the PRISMA 2020 guidelines, this study analyzed 28 hospital-level studies published in Scopus-indexed journals (Q1–Q3) between 2015 and 2026. The findings indicate that 67.9% of the reviewed studies reported positive associations between payment reforms and hospital performance, particularly in process-based quality indicators, readmission outcomes, and selected efficiency measures. However, the effects on mortality, equity, utilization, and cost efficiency remain heterogeneous and context-dependent. The effectiveness of reforms is influenced by incentive magnitude, payment model type, indicator specificity, regulatory environment, baseline institutional performance, and digital monitoring capacity. These findings suggest that financial incentives are more effective when integrated into coherent governance and accountability systems.
Co-Authors I Made Suidarma Ida Ayu Oka Martini Nyoman Sri Subawa