Pay for Quality (P4Q) is the mechanism by which the remuneration of a healthcare service directly depends on the achieved results in terms of structure, processes and/or outcome indicators. Interest for P4Q is growing, in Belgium and abroad. What are the effects and side effects of P4Q programs? What are the necessary conditions to apply international P4Q models or to add P4Q components to already existing Belgian initiatives? This report of the Centre of Excellence makes a thorough evaluation of Pay for Quality programs.