OBJECTIVES: To identify and characterize publicly available cases and related trends for performance-based schemes. METHODS: We performed a systematic review of performance-based schemes over the past 15 years (1996 – 2011) using publicly available databases and reports from colleagues and health care experts. These were categorized according to a previously published taxonomy of scheme types and assessed in terms of the underlying product and market attributes for each scheme.  Macro-level trends were identified related to the timing of scheme adoption, countries involved, types of schemes, and product and market factors.  RESULTS: Our search yielded in excess of 110 schemes.  From this set, we identified: 58 schemes that included a coverage with evidence development component, 25 that included a conditional treatment continuation component, 35 that included a performance-linked reimbursement component, and 37 that included a patient level financial utilization component.  Each type of scheme addresses fundamental uncertainties that exist when products enter the market.  There has been a continued upward trend in terms of total schemes adopted per year and the number of countries with performance-based schemes in place.  Despite the continued enthusiasm, challenges persist including those related to: 1) the cost and burden of implementation; 2) the need for consistent processes for scheme development, data collection, reporting, and evaluation; and 3) negotiating follow-on agreements after scheme initiation.  Furthermore, the challenges faced differ by country, health system, and product. CONCLUSIONS: There is continued enthusiasm in many countries for using performance-based schemes for new medical products.  Given the interest to date and the potential to meet the goals of interested stakeholders, these schemes may become a common element in health care coverage and reimbursement.  However, significant challenges persist, and future studies are needed regarding the attitudes and perceptions of various stakeholders as well as evaluating the results and experiences with the schemes implemented thus far.