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Table 3 Summary analysis

From: Selecting effective incentive structures in health care: A decision framework to support health care purchasers in finding the right incentives to drive performance

Principle

Consequences for selecting incentives

Recommendation

(1) Be fiscally prudent

Incentives should not lead to additional costs for the health care system (no new money).

Exclude funding of bonuses/enhanced payment through new money without added value or without future savings.

(2) Be simple to administer

Incentive should be easy to implement and ideally be executed within existing policies, regulation and legislation.

Exclude 'Flexible oversight/greater autonomy' as an incentive as its design and implementation are too complex or might conflict with existing legislation or regulations.

(3) Improve equity in access to quality of health care services across Ontario

Incentives should not lead to differences in access to quality of health care services; instead, if possible, strengthen equity.

Exclude withhold of existing funding based on performance.

Exclude bonus/enhanced payment funding via reallocation of funding from low to high performers.

(4) Support a culture of continues improvement, innovation and mutual learning

Incentives should:

- not lead to tensions between ministry – LHIN and LHIN – health service providers.

- focus on learning and improving rather than blaming.

- encourage the sharing of best practices across LHINS and LHIN providers.

Exclude withholding of existing funding based on performance.

Design public reporting in such a way that it prevents a "shame and blame" culture.