Performance-based payments and intrinsic motivation among primary healthcare workers in China: a cross-sectional...

The study aimed to examine whether pay-for-performance (performance-based payment (PBP)) may crowd out intrinsic motivation by analysing the association between the proportions of the PBP component of the total salary and intrinsic motivation levels among primary healthcare workers in China.

A cross-sectional survey. The primary outcome was intrinsic motivation, measured using the intrinsic motivation subscale of the 15-item work motivation scale.

The study involved 1927 primary healthcare workers from 31 institutions in Weifang city, Shandong province, China.

The proportion of PBP was the primary intervention variable. Additionally, subanalysis was conducted across different performance dimensions, including whom to incentivise and the domain of performance measured.

The results revealed a complex relationship between the proportion of the PBP component of the total salary and intrinsic motivation levels among primary healthcare workers. Overall, higher PBP proportions were associated with increased intrinsic motivation scores (β=0.49, p<0.05), particularly when incentives targeted groups rather than individuals (β=1.04, p<0.05) and when both the quantity and quality of care were included in performance measurement (β=0.61, p<0.05). However, when performance was measured solely based on the number of healthcare visits, a significant negative impact on intrinsic motivation was observed (β=-1.19, p<0.05).

This study underscored the importance of designing PBP schemes to enhance performance without undermining intrinsic motivation among primary healthcare workers. PBP schemes should not only focus on increasing financial incentives but also incorporate incentive methods that acknowledge healthcare workers' professional contributions and expertise. These findings were crucial for policymakers and healthcare administrators aiming to optimise PBP schemes to enhance performance and ensure the sustainability of the effectiveness of these schemes by preserving intrinsic motivation among China's primary healthcare workers.