A joint study conducted by the Chapidze Emergency Cardiology Center and Caucasus University, titled “Performance-based financing as a quality governance reform in primary health care: workforce perspectives,” has been published in the A-level international peer-reviewed British journal International Journal of Health Governance.
The authors of the article are Tengiz Verulava and Revaz Jorbenadze.
Article link.
Citation:
Verulava, T., & Jorbenadze, R. (2026). Performance-based financing as a quality governance reform in primary health care: workforce perspectives. International Journal of Health Governance, 1–13. https://doi.org/10.1108/IJHG-03-2026-0059
The International Journal of Health Governance is indexed in the international scientific database Scopus, has a CiteScore of 4.3, and is ranked as an A-level journal.
Scopus source information.
The research was conducted through cooperation between Caucasus University and the Academician G. Chapidze Emergency Cardiology Center. The two institutions have collaborated for many years on joint scientific research projects, demonstrating their strong partnership in the fields of clinical research and academic activity.
Summary
The study examines the reform of primary health care financing in Georgia. In July 2025, Georgia introduced a significant change to its primary health care financing system: uniform capitation was replaced by age-adjusted capitation, and performance-based payment mechanisms were introduced, linked to indicators for preventive services and chronic disease management.
The reform aims to strengthen prevention, improve the early detection of diseases, and achieve measurable improvements in the quality of primary health care. This approach is consistent with the international trend toward value-based health care. However, its success depends largely on how the reform is implemented in practice and how it is perceived by health care professionals.
Pay-for-Performance (P4P) is an important financial mechanism for improving the quality of health care. It links part of a provider’s remuneration to the achievement of predefined quality and outcome indicators. At the primary health care level, this approach is particularly aimed at improving preventive services, early disease detection, and the management of chronic conditions.
The study examines how age-adjusted capitation and performance-based remuneration affect the work processes of medical personnel, accountability, perceptions of fairness, and professional roles.
The findings showed that the new financing model contributed to a shift toward a more preventive and population-health-oriented approach in primary care. At the same time, the study identified a number of challenges, including an increased administrative burden, an imbalance between greater accountability and the limited involvement of professionals in decision-making, as well as difficulties in adapting standardized performance indicators to local socioeconomic and regional conditions.
The perceived fairness and transparency of the evaluation system proved particularly important, as these factors significantly influence professionals’ trust in and engagement with the reform.
Thus, performance-based financing is not merely a financial incentive mechanism; it is also an important instrument for governing the quality of primary health care. Its effectiveness depends not only on the proper design of financial incentives and performance indicators, but also on the quality of governance, the fairness and transparency of the evaluation system, consideration of the local context, and the active participation of medical professionals.
Accordingly, health care professionals should be viewed not simply as implementers of reform, but as full partners in improving quality and further developing the reform.
Health Policy Center
Caucasus University
