There is a trend towards introducing greater accountability for quality and efficiency in provider payment systems, which generally requires a combination of fee-for-service, pay-for-performance and capitated payments. The optimal combination of these systems, however, needs be decided by the authorities on practical grounds. There are welcome steps taken to align outpatient and homogenous disease group (HDG) points so that therapeutically equivalent treatments are rewarded equally regardless of the setting in which health services are offered.