Performance-based payment systems for general practitioners and specialists in selected countries: a comparative...

Area of Science:

• Health Policy and Management
• Health Economics
• Comparative Health Systems

Background:

• Rising demands on health system financial and human resources necessitate efficient management strategies.
• Performance-based payment (PBP) has emerged as a key policy tool for health and welfare policymakers.
• Understanding PBP components is crucial for optimizing resource allocation and system performance.

Purpose of the Study:

• To conduct a comparative analysis of the components of performance-based payment systems in selected countries.
• To identify commonalities and variations in PBP implementation across different health insurance, system development, and economic contexts.

Main Methods:

• A comparative study was conducted in 2021, selecting countries based on health insurance type, PBP system development, and economic status.
• Comparative analysis tables were used to organize findings.
• A general framework for PBP systems (goals, activities, participants, incentives/penalties) guided the analysis.

Main Results:

• Clinical quality consistently received the highest weighting in most PBP programs analyzed.
• Other significant dimensions included patient experience and satisfaction, physician financial performance, and patient access to services.
• Risk adjustment methods (e.g., exception reporting, combined payments, demographic adjustments) were commonly employed to mitigate provider risk, with active clinical provider involvement in program design.

Conclusions:

• Performance-based payment programs are widely adopted but face inherent limitations.
• Linking incentives to performance at individual, team, and organizational levels can foster improved teamwork and integrated healthcare delivery.