ObjectiveTo systematically review the efficacy of pay-for-performance (P4P) for primary care physicians (PCPs). MethodsThe Cochrane Library, Database of Abstracts of Reviews of Effects, EMbase, Web of Science, PubMed, Dissertations and Theses Database, EconLit, CNKI, WanFang Data, IDEAS, and POPLINE were searched to collect studies on the efficacy of P4P for PCPs from inception to May 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Statistical analysis was then performed by using RevMan 5.4 software. ResultsA total of 10 studies were included. The results of meta-analysis showed that P4P incentives possibly improved child immunization status (RR=1.27, 95%CI 1.19 to 1.36, P<0.001), slightly improved primary care physicians’ prescribing of guideline-recommended antihypertensive medicines compared with existing payment method (RR=1.07, 95%CI 1.02 to 1.12, P=0.006), and improved a mixed outcome measure of service provision and patient health outcomes (RR=1.13, 95%CI 1.04 to 1.23, P=0.004). ConclusionsCurrent evidence shows that P4P possibly increases the quantity of health service provision and improve quality of service provision for targeted populations. The effects of P4P on health outcomes is uncertain. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.