Key Indicators of Performance-Based Payment to Physicians by Insurance Organizations in Iran

A fair and transparent payment system has been shown to influence workforce motivation and quality of work. Performance-based payment initiatives are designed to strengthen this relationship by linking compensation to measurable outcomes. This study aimed to identify the key indicators of performance-based payment for physicians in Iran.

This mixed-method study employed a scoping review and semi-structured interviews with key professionals and practitioners in health insurance, health economics, and management. The scoping review followed the Arksey and O'Malley framework and covered publications from 2000 to 2024 in both Persian and English databases. Interview data were analyzed using a thematic analysis approach with the assistance of MAXQDA software. A prioritization matrix was applied to determine the final set of key indicators.

Eighteen key indicators were identified through review, qualitative analysis, and screening stages. The main indicators included the per capita number of expensive diagnoses or procedures prescribed within a given period, adherence to clinical guidelines, per capita number of services provided by a physician, and compliance with electronic service delivery (e.g., use of PMR and electronic prescriptions).

Key performance indicators and managerial dashboards are critical tools for enhancing efficiency, equity, and quality in the health sector. The use of such indicators by purchasing and insurance organizations can motivate providers to prioritize quality and responsiveness while effectively managing healthcare costs.