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Experiences of general practices with a participatory pay-for-performance program: a qualitative study in primary
Kirsten Kirschner1, Jozé Braspenning, J E Annelies Jacobs
1Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, The Netherlands. k.kirschner@iq.umcn.nl
Australian Journal of Primary Health
|September 8, 2012
Summary
Pay-for-performance programs in primary care are labor-intensive but stimulate quality improvement. However, unintended consequences like
Area of Science:
- Health Services Research
- Primary Care Medicine
- Health Economics
Background:
- Pay-for-performance (P4P) programs aim to improve healthcare quality.
- Understanding participant experiences in P4P is crucial for program design and effectiveness.
- Little is known about general practices' views on P4P implementation.
Purpose of the Study:
- To explore general practices' experiences with P4P in primary care.
- To investigate participant views on feasibility, feedback, financial incentives, and unintended consequences of P4P.
Main Methods:
- Qualitative study involving semi-structured interviews.
- Conducted in 29 general practices in the Netherlands participating in a P4P program.
- Content analysis of interview transcripts.
Main Results:
- P4P programs require significant time investment, questioning feasibility.
- Feedback was used for improvement but caused annoyance and insecurity for some GPs.
- Bonuses were seen as a quality stimulus and compensation, mainly spent on equipment and team building.
- Unintended consequences included gaming and 'tunnel vision' on incentivized aspects.
- Future developments suggested include absolute thresholds, new indicators, and independent audits.
Conclusions:
- P4P is a labor-intensive but positive breakthrough for quality improvement in primary care.
- Careful consideration of unintended consequences and indicator set sustainability is essential.
- Participant involvement in P4P design may enhance program impact.
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