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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