BACKGROUND AND OBJECTIVES: Pay-for-performance is a financial incentive which links physicians' income to the quality of their services. Although Pay-for-performance(P4P) is suggested to be an effective payment method in many pilot countries (i.e. the United Kingdom) and enjoys a wide application in primary health care, researches on it are yet to reach an agreement. Thus a systematic review was conducted on the evidence of impact of P4P on behavior of primary care physicians and patient outcomes aiming to provide a comprehensive and objective evaluation of P4P for decision makers. METHODS: Studies were identified by searching PubMed, EMbase and The Cochrane Library. Electronic search was conducted in the fourth week of January, 2013. As the included studies had significant clinical heterogeneity, a descriptive analysis was conducted. Quality Index was adopted for quality assessment of evidences. RESULTS: Database searches yielded 651 candidate articles, of which 44 studies fulfilled the inclusion criteria. An overall positive effect was found on the management of disease, which varied in accordance with the baseline medical quality and the practice size. Meanwhile, it could bring about new problems regarding the inequity, patients' dissatisfaction and increasing medical cost. CONCLUSIONS: Decision makers should consider the baseline conditions of medical quality and the practice size before new medical policies are enacted. Furthermore, most studies are retrospective and observational with high level of heterogeneity though, the descriptive analysis is still of significance. This article is protected by copyright. All rights reserved