Keywords
Abstract
Summary
Context: One of the essential conditions for providing quality healthcare services is the presence of capable physicians with high performance levels. To improve physicians' performance, an effective performance-based payment system can achieve three goals: productivity, high-quality clinical services, and patient satisfaction. The aim of this study is to design a performance-based payment model for physicians in outpatient clinics contracted with the Iran Health Insurance Organization, tailored to the context and structure of this organization.
Methodology: This study is a mixed-methods study in which data were collected and analyzed using both quantitative and qualitative methods. In this study, through literature review and interviews with experts, the determining indicators for performance-based payments to general and specialized physicians in the outpatient sector who have direct contracts with the Health Insurance Organization were identified, along with the criteria for selecting these indicators. The extracted indicators were reviewed in several expert panels, and the indicators were entered into a prioritization matrix according to the structures of health insurance. In this phase, 49 questionnaires were completed, ultimately leading to the formulation of the operational framework for the indicators.
Results: From the aggregation of findings from the systematic review of literature and interviews, 47 determining indicators for performance-based payments to physicians and 18 criteria for the final selection of these indicators were extracted. Ultimately, with the entry of 24 selected indicators from the expert panel into the prioritization matrix, 9 indicators for general physicians and 13 indicators for specialized physicians were chosen. These indicators were categorized into three statuses: current, transitional, and desired, in accordance with the infrastructures of the Health Insurance Organization and its partner organizations. Selected indicators included the average number of prescribed medications, registered and sent electronic prescriptions, per capita number of prescribed diagnostic procedures, timely presence of physicians, complaints against physicians, physicians' work history, adherence to guidelines in physicians' decision-making, completion of electronic patient records, patient satisfaction, participation in training courses, and the average number of tests prescribed by physicians. The indicator profile contained the indicator title, indicator formula, indicator standard, method of data collection, and data source.
Conclusion: Policymakers can direct physicians' performance towards the goals of the insurance organization, such as reducing costs, accelerating processes, and increasing patient satisfaction, by utilizing the selected indicators in the pay-for-performance (P4P) system. The identified indicators assess various aspects of physicians' performance and will provide a basis for improving their performance by clarifying the organization's objectives for them.
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