Table 1 Features of P4P schemes and their dimensions
From: Pay-for-performance in disease management: a systematic review of the literature
Feature | Dimensions |
|---|---|
1. Type | • Reward: incentive implies increase in payments • Penalty: incentive implies decrease in payments |
2. Nature incented entity | • Individual: incentive is granted to an individual (e.g. healthcare provider such as GP) • Group: incentive is granted to a group (e.g. clinical team, GP practice, hospital trust) |
3. Focal quality behavior targeted by incentive | • Structure: incentives are based on resources assembled to deliver care (including personnel, facilities, IT, and materials) • Process: incentives are based on the completion of specific tasks or recommended treatments (e.g. performance measures, clinical quality) • Outcome: incentives are based on ultimate results of care (e.g. patient experience, health status, morbidity, and mortality) |
4. Scope | • General: incentives target at general domain of quality (e.g. payment for each patient enrolled in disease management program). • Selective: incentives target a specific domain of quality (e.g. periodic blood pressure readings or cholesterol screening) |
5. Motivation | • Intrinsic: incentive affects intrinsic motivation to deliver high quality care (e.g. patient benefit) • Extrinsic: incentive affects extrinsic motivation to deliver high quality care (e.g. economic interest) |
6. Scale | • Relative: incentive is paid for achieving a given comparative ranking among providers (e.g. hospitals in top 2 performing quartiles are offered increases in tariff payments) • Absolute: incentives is paid for a continuous gradient of quality improvement (e.g. sickness funds receive higher payments for each patient enrolled in disease management program) |
7. Size | • Amount of money provided or withdrawn |
8. Certainty | • Certain: incented entity is certain about achievability of targets (e.g. targets seem easily achievable; guaranteed reward schedule) • Uncertain: incented entity is uncertain about achievability of targets (e.g. targets seem not easily achievable; competition for limited funds) |
9. Frequency and duration | • Frequency: number of times a year an incentive is provided • Duration: number of years an incentive is provided |