Pay-for-performance in resource-constrained settings: Lessons learned from Thailand’s Quality and Outcomes Framework

In 2010, Thailand introduced the first pay-for-performance (P4P) programme, called on-top payment, in order to reduce variations in quality and accessibility of care provision by encouraging CUPs to improve infrastructure and staffing. Since this programme was criticized for not clearly contributing to the quality of services and health outcomes, it was replaced by the Quality and Outcomes Framework (QOF) in October 2013. As a P4P initiative, the QOF incentivizes health providers to improve primary care quality in key predetermined areas, namely (i) health promotion and disease prevention; (ii) primary healthcare services; (iii) organizational development and management; and (iv) services targeted to local need. Lessons learned from the current Thai QOF will be useful for policy makers and programme implementers at both the national and international levels in ensuring effective policy transfer and implementation, not only for similar P4P programs, but also for other public health initiatives.