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 |