Keywords
Abstract
Context: due to the growing increase in the needs of health systems in the field of financial and human resources management, as well as the challenges related to enhancing the quality of health care, performance-based payment has been the subject of attention by health and welfare policymakers. This study aimed to compare the components of performance-based payment in selected countries.
Methods: This comparative study was conducted in 2021. The search was performed in two search engines (Google Scholar and Google), three databases (Medline, Scopus, and Web of Science), and the websites of WHO and the Ministry of Health and Welfare of the selected countries. The selection of countries was based on three measures: the type of health insurance system, the development of the performance-based payment system, and the state of economic development of the countries. Finally, England, Taiwan, United States of America, Canada, Germany, Turkey, France, and Iran were included in this study. The findings were organized using comparative analysis tables. The general framework of performance-based payment systems, including goals, activities and actions, people involved in the program, and the way of encouraging and punishing, was used for analysis.
Results: The findings of the study showed that in most of the programs, aspect of clinical quality has the highest weight. Other dimensions include patient experience and satisfaction, physician financial performance, and patients’ access to services. In most programs, various risk adjustment methods such as exception reporting, combined payments, payment according to demographic characteristics, were used to reduce provider risk, and clinical service providers were actively involved in the program design. In several programs incentive payments were made at the group level. The method of payment in several programs was also staggered and progressive.
Conclusion: In general, developed countries have formal performance-based payment systems with different mechanisms. On the other hand, in most developing countries, scattered measures have been taken in this field. Despite the widespread use of performance-based payment programs in most countries, these programs face limitations and shortcomings. By linking incentives to individual, team, and organizational performance, a performance-based payment program can increase clinicians’ morale capacity, improve teamwork, and create integrated health care.
References
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