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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 Size • Amount of money provided or withdrawn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