Assessment of a pay-for-performance program in primary care designed by target users

Fam Pract. 2013 Apr;30(2):161-71. doi: 10.1093/fampra/cms055. Epub 2012 Sep 20.


Background: Evidence for pay-for-performance (P4P) has been searched for in the last decade as financial incentives increased to influence behaviour of health care professionals to improve quality of care. The effectiveness of P4P is inconclusive, though some reviews reported significant effects.

Objective: To assess changes in performance after introducing a participatory P4P program.

Design: An observational study with a pre- and post-measurement. Setting and subjects. Sixty-five general practices in the south of the Netherlands. Intervention. A P4P program designed by target users containing indicators for chronic care, prevention, practice management and patient experience (general practitioner's [GP] functioning and organization of care). Quality indicators were calculated for each practice. A bonus with a maximum of 6890 Euros per 1000 patients was determined by comparing practice performance with a benchmark.

Main outcome measures: Quality indicators for clinical care (process and outcome) and patient experience.

Results: We included 60 practices. After 1 year, significant improvement was shown for the process indicators for all chronic conditions ranging from +7.9% improvement for cardiovascular risk management to +11.5% for asthma. Five outcome indicators significantly improved as well as patients' experiences with GP's functioning and organization of care. No significant improvements were seen for influenza vaccination rate and the cervical cancer screening uptake. The clinical process and outcome indicators, as well as patient experience indicators were affected by baseline measures. Smaller practices showed more improvement.

Conclusions: A participatory P4P program might stimulate quality improvement in clinical care and improve patient experiences with GP's functioning and the organization of care.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Benchmarking
  • Follow-Up Studies
  • General Practice / economics*
  • General Practice / organization & administration
  • Humans
  • Models, Statistical
  • Netherlands
  • Outcome and Process Assessment, Health Care
  • Patient Satisfaction
  • Physician Incentive Plans / economics*
  • Physician Incentive Plans / organization & administration
  • Primary Health Care / economics*
  • Primary Health Care / organization & administration
  • Program Evaluation
  • Quality Improvement / economics*
  • Quality Improvement / organization & administration
  • Quality Indicators, Health Care
  • Reimbursement, Incentive / organization & administration*