In some examples, it appears that other non-financial changes were at least as important as the payment mechanism change. For example, there are notable improvements in the quality' of care in the new FHUs in Portugal, where P4P is a significant component of payment, but the payment reform w'as accompanied by significant organisational change. Even if areas targeted by P4P are showing improvements, these improvements might need to be seen in context of other broader dimensions, such organisational change in Portugal and Canada, and a broader reform agenda aimed at improving quality of care in Norway, for example.