Skip to main content

Table 2 Healthcare Incentives Reporting Framework (HISReF) - a template for reporting standard features of P4P schemes

From: A reporting framework for describing and a typology for categorizing and analyzing the designs of health care pay for performance schemes

Core design features Variables Description
Who receives the incentives? Individuals Incentive is paid to an individual health care provider e.g. physician
Groups Incentive is paid to a group and individual clinicians might not benefit from the incentive directly e.g. hospital trust, clinical team, general physician (GP) practice, NGO, levels of government, faith based organizations
Type of incentive Bonuses Incentive is in the form of increase in payments, bonus, gifts, peer recognition etc.
Fines Negative incentives in the form of reduction in expected payments, penalty, punishment etc.
Type of payment Monetary Incentive in form of money
Non-Monetary Incentives in the form of material things or tangible gifts
Size of incentive Large Monetary or non-monetary reward or fine- > 10% of salary, budget, or anticipated payment
Medium Monetary or non-monetary reward or fine 5–10% of salary, budget, or anticipated payment
Small Monetary or non-monetary reward or fine < 5% of salary, budget, or anticipated payment
Payment mechanism Absolute Incentives are paid as a single payment for an absolute increase in performance for example, an 80% increase in performance.
Tiered thresholds Incentives are paid for a series of target thresholds to meet for example paying increasing incentives for achieving a 65%, an 80%, and a 90% performance threshold.
Method of payment Coupled Incentives paid are coupled with usual reimbursement e.g. an incentive in form of an increase in salary.
Decoupled Incentives are paid separately from the usual reimbursement.
Performance measure/payment scale Absolute measure Incentive is paid for improvement in performance or behaviour change not dependent on other providers e.g. incentive paid per patient immunized
Relative measure Incentive is paid for attaining a level of performance relative to other providers e.g. incentives paid to clinicians or hospitals above the median performance
Domain of performance measured Within clinicians control Incentive payments are based on process and structural outcomes e.g. having the right equipment, the number of children immunized, routine measurement of blood pressure of patients every month
Out of clinicians control Payment of incentives to health providers for ultimate health outcomes e.g. reduction in mortality rates from a specific disease
Time lag Short Payment of incentives four months or less after measurement of performance
Long Payment of incentives more than four months after measurement of performance