OBJECTIVES: To review the current risk-sharing and pay-for-performance models in indexed literature and to describe characteristics and outcomes obtained after the implementation of these models. METHODS: We conducted a review of the literature in Medline, Embase and Lilacs, using the free terms "risk sharing", "risk management" and "pay for performance", without language or publication date limits. Economic studies, systematic and non-systematic reviews of the literature, as well as descriptive studies about risk-sharing and international payment models were included. RESULTS: Of the 1009 articles initially identified, 35 were included for the analysis. Most sturies come from United States and the UK, but there are also experiences form Belgium, Italy, Spain, South Africa, Sweden; there are also documented experiences from Philippines, Tanzania, Zambia, Rwanda, Burundi, Democratic Republic of Congo, Vietnam, Peru, and China. Implementation of risk-sharing models had good overall performance and most papers show a significant improvement in different variables, such as decreased mortality and improvement in quality of care provided to patients mostly with chronic diseases. Payment arrangements between health care providers and pharmaceutical industry facilitated the implementation of new technologies in different health care systems. CONCLUSIONS: Due to the diversity of interventions and of healthcare system structures, the evidence available is still insufficient to draw conclusions. “Risk sharing” includes a wide range of approaches, is far from a uniform intervention, and depends on the interaction of numerous variables, including the magnitude and distribution of the incentives, and the amount of technical support available.