OBJECTIVES: Numerous studies have revealed that many health care systems can be characterized by ineffectiveness and inefficiency. One approach to improve the quality of health care that has become increasingly popular is Pay-for-Performance (P4P). P4P links payments to performance on predefined quality measures. To date, P4P has become a part of several health care systems. However, previous published studies evaluating P4P programs show that the effects are heterogenic and conclude that P4P has the potential to enhance quality of healthcare. Therefore, this analysis aims at assessing P4P effectiveness and success factors of prospective programs. METHODS: A systematic literature search on P4P-reviews published between 2000 and 2012 was conducted in PubMed and Cochrane Database of Systematic Reviews. The literature searches provided 297 citations for inclusion. After different exclusion steps (title, abstract, and full-text screening) and an additional hand search, nine reviews were included. The literature search is based on the recommendations of Cochrane Collaboration and the Institute for Quality and Efficiency in Healthcare. The methodological quality of each review was assed using the AMSTAR-checklist. RESULTS: In sum, reviews analyse 75 different primary studies. Most of the studies focus on the US (47) and the UK (19). In 60 evaluations, primary studies are categorised as having positive effects. P4P is linked to negative results in 16 studies. Nevertheless, in 61 cases the results are assessed to have positive and negative effects. Success factors of P4P programs contain of three key issues: (1) What to incentivize: Dimensions of performance; (2) Whom to incentivize: Individuals or groups; (3) How to incentivize: Rewards or penalties/incentive size/absolute or relative performance/frequency and duration. CONCLUSIONS: Reviews confirm that P4P can improve quality of care, though not always. Therefore, financial incentives have to be designed and implemented carefully. Better-designed studies are needed to determine success factors for quality improvement.