OBJECTIVES: Different payment schemes have been implemented in Europe to stimulate integrated chronic care and to reduce health care expenditure. We aimed to investigate the impact of different payment schemes on national total health care expenditures. METHODS: We first identified European countries with payment reforms directed at integrated chronic care. Further, we conducted 14 interviews with chronic care experts in England, the Netherlands, Germany, Denmark, Austria, and France to get detailed information about the reforms and the facilitators and barriers for implementation. Last, we used a difference-in-differences (DID) model to estimate differences in health care expenditure trends before and after the introduction of a payment scheme between intervention countries and control countries. Intervention countries included countries with a pay-for-coordination (P4C), pay-for-performance (P4P), and/or bundled payment for integrated chronic care. We used OECD and WHO data from 1996 to 2010. RESULTS: The interviews showed that P4C in Austria, Denmark and France failed to control growing health care expenditure. This was attributed mainly to misaligned incentives between public insurers and local authorities. In contrast, P4P in France and England appeared to have a positive impact on reducing costs. The large financial incentives for care providers and explicit activity-based guidelines were the most important success factors. Bundled payments in the Netherlands and Germany increased transparency and promoted quality of care but at higher costs. These findings are in line with the quantitative results where the health care expenditure per capita decreased by 70 euro (p=0.002) after the implementation of P4P and increased by 75 euro (p=0.040) after the implementation of  bundled payments. The P4C had an insignificant effect. CONCLUSIONS: Payment schemes are potentially powerful tools to stimulate the delivery of integrated care and influence health care expenditure. P4P appears to be the most appealing in reducing health care expenditure.