IMFIN brief 14: How provider payment approaches affect immunization services

What are the pros and cons of the various approaches to paying providers for immunization services? What kinds of incentives do they create?

Key points

• The methods used to pay health care providers to deliver immunization services affect the incentives providers have to make immunization a priority.
• The most common provider payment methods are line-item or global budgets, fee-for-service payments, and capitation payments. Each method has strengths and weaknesses, so they are often combined or used with performance-based incentives. Some countries are experimenting with tying performance incentives to immunization coverage targets.
• Performance-based payment for immunization has the potential to increase coverage, but results have been inconclusive in low- and middle-income countries. Sustainability is a concern when these programs are donor-supported.
• The right mix of payment methods depends on the country context, so good monitoring systems are needed to track the effects of incentives on immunization.