An increasing interest is emerging in ecological compensation or biodiversity offsets as an instrument for slowing down the rate of biodiversity losses, with programs ongoing in more than 40 countries. Adhering to the polluter-pays principle, the instrument requires the intervening party to compensate for environmental degradation that has occured as a result of development. However, its use is contested as the instrument may facilitate a ‘license to trash’ if more development permits are allowed under the assumption that the degradation can simply be compensated. This paper increases the understanding of whether existing programs for ecological compensation effectively addresses the loss of biodiversity and ecosystem services. A literature review is conducted with five case studies of ecological compensation programs representing middle- and high- income countries. We begin by describing the different approaches of designing compensation programs in Australia, England, Germany, South Africa and the U.S. Key issues in the program design are reviewed: policy goals, adherence to the mitigation hierarchy, weighting of losses and gains, and monitoring activities. We then evaluate the programs’ outcomes, in terms of the ecological and social benefits provided. From these case studies, we find three design aspects that may contribute towards improving the compensation programs’ outcomes: (1) integration of compensation programs with conservation landscape planning, (2) adequate commensurability of ecosystem functions and (3) an open access centralised reporting system. We also identify four safeguards to contribute towards protecting the ecological and social benefits: (1) allocate co-responsibilities of equivalence weighting and monitoring to an independent, external organisation, (2) consider local livelihoods at both the impact and proposed compensation site, (3) ensure access to recreation and (4) stakeholder participation from the general society and consultation of the directly affected community. We highlight that the use of this controversial instrument requires considerable regulation and capacity, with democratically decided performance criteria.