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Key issues in the design of pay for performance programs

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  • Frank Eijkenaar

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Abstract

Pay for performance (P4P) is increasingly being used to stimulate healthcare providers to improve their performance. However, evidence on P4P effectiveness remains inconclusive. Flaws in program design may have contributed to this limited success. Based on a synthesis of relevant theoretical and empirical literature, this paper discusses key issues in P4P-program design. The analysis reveals that designing a fair and effective program is a complex undertaking. The following tentative conclusions are made: (1) performance is ideally defined broadly, provided that the set of measures remains comprehensible, (2) concerns that P4P encourages “selection” and “teaching to the test” should not be dismissed, (3) sophisticated risk adjustment is important, especially in outcome and resource use measures, (4) involving providers in program design is vital, (5) on balance, group incentives are preferred over individual incentives, (6) whether to use rewards or penalties is context-dependent, (7) payouts should be frequent and low-powered, (8) absolute targets are generally preferred over relative targets, (9) multiple targets are preferred over single targets, and (10) P4P should be a permanent component of provider compensation and is ideally “decoupled” form base payments. However, the design of P4P programs should be tailored to the specific setting of implementation, and empirical research is needed to confirm the conclusions. Copyright The Author(s) 2013

Suggested Citation

  • Frank Eijkenaar, 2013. "Key issues in the design of pay for performance programs," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(1), pages 117-131, February.
  • Handle: RePEc:spr:eujhec:v:14:y:2013:i:1:p:117-131
    DOI: 10.1007/s10198-011-0347-6
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    References listed on IDEAS

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    Citations

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    Cited by:

    1. Søren Rud Kristensen & Mickael Bech & Jørgen T. Lauridsen, 2016. "Who to pay for performance? The choice of organisational level for hospital performance incentives," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(4), pages 435-442, May.
    2. Anell, Anders & Dietrichson, Jens & Ellegård, Lina Maria, 2015. "Can Pay-for-Performance to Primary Care Providers Stimulate Appropriate Use of Antibiotics?," Working Papers 2015:36, Lund University, Department of Economics, revised 29 Jun 2016.
    3. Kristensen, Søren Rud & Siciliani, Luigi & Sutton, Matt, 2016. "Optimal price-setting in pay for performance schemes in health care," Journal of Economic Behavior & Organization, Elsevier, vol. 123(C), pages 57-77.
    4. Girault, Anne & Bellanger, Martine & Lalloué, Benoît & Loirat, Philippe & Moisdon, Jean-Claude & Minvielle, Etienne, 2017. "Implementing hospital pay-for-performance: Lessons learned from the French pilot program," Health Policy, Elsevier, vol. 121(4), pages 407-417.
    5. Iezzi, Elisa & Lippi Bruni, Matteo & Ugolini, Cristina, 2014. "The role of GP's compensation schemes in diabetes care: Evidence from panel data," Journal of Health Economics, Elsevier, vol. 34(C), pages 104-120.
    6. Fiorentini, Gianluca & Lippi Bruni, Matteo & Ugolini, Cristina, 2013. "GPs and hospital expenditures. Should we keep expenditure containment programs alive?," Social Science & Medicine, Elsevier, vol. 82(C), pages 10-20.
    7. Ammi, Mehdi & Fortier, Grant, 2017. "The influence of welfare systems on pay-for-performance programs for general practitioners: A critical review," Social Science & Medicine, Elsevier, vol. 178(C), pages 157-166.
    8. Milstein, Ricarda & Schreyoegg, Jonas, 2016. "Pay for performance in the inpatient sector: A review of 34 P4P programs in 14 OECD countries," Health Policy, Elsevier, vol. 120(10), pages 1125-1140.
    9. Krauth, Christian & Liersch, Sebastian & Jensen, Sören & Amelung, Volker Eric, 2016. "Would German physicians opt for pay-for-performance programs? A willingness-to-accept experiment in a large general practitioners’ sample," Health Policy, Elsevier, vol. 120(2), pages 148-158.
    10. repec:zbw:hkjalm:175336 is not listed on IDEAS
    11. Eijkenaar, Frank & Emmert, Martin & Scheppach, Manfred & Schöffski, Oliver, 2013. "Effects of pay for performance in health care: A systematic review of systematic reviews," Health Policy, Elsevier, vol. 110(2), pages 115-130.
    12. John Buckell & Andrew Smith & Roberta Longo & David Holland, 2013. "Health inefficiency and unobservable heterogeneity - empirical evidence from pathology services in the UK National Health Service," Working Papers 1307, Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds.
    13. Baxter, Pamela E. & Hewko, Sarah J. & Pfaff, Kathryn A. & Cleghorn, Laura & Cunningham, Barbara J. & Elston, Dawn & Cummings, Greta G., 2015. "Leaders’ experiences and perceptions implementing activity-based funding and pay-for-performance hospital funding models: A systematic review," Health Policy, Elsevier, vol. 119(8), pages 1096-1110.

    More about this item

    Keywords

    Compensation methods; Incentive reimbursement; Pay for performance; Program design; Provider behavior; D03; D86; I11; J31; J33;

    JEL classification:

    • D03 - Microeconomics - - General - - - Behavioral Microeconomics: Underlying Principles
    • D86 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Economics of Contract Law
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • J31 - Labor and Demographic Economics - - Wages, Compensation, and Labor Costs - - - Wage Level and Structure; Wage Differentials
    • J33 - Labor and Demographic Economics - - Wages, Compensation, and Labor Costs - - - Compensation Packages; Payment Methods

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