Table 1

Features of P4P schemes and their dimensions

Feature

Dimensions

1. Type

• Reward: incentive implies increase in payments

• Penalty: incentive implies decrease in payments

2. Nature incented entity

• Individual: incentive is granted to an individual (e.g. healthcare provider such as GP)

• Group: incentive is granted to a group (e.g. clinical team, GP practice, hospital trust)

3. Focal quality behavior targeted by incentive

• Structure: incentives are based on resources assembled to deliver care (including personnel, facilities, IT, and materials)

• Process: incentives are based on the completion of specific tasks or recommended treatments (e.g. performance measures, clinical quality)

• Outcome: incentives are based on ultimate results of care (e.g. patient experience, health status, morbidity, and mortality)

4. Scope

• General: incentives target at general domain of quality (e.g. payment for each patient enrolled in disease management program).

• Selective: incentives target a specific domain of quality (e.g. periodic blood pressure readings or cholesterol screening)

5. Motivation

• Intrinsic: incentive affects intrinsic motivation to deliver high quality care (e.g. patient benefit)

• Extrinsic: incentive affects extrinsic motivation to deliver high quality care (e.g. economic interest)

6. Scale

• Relative: incentive is paid for achieving a given comparative ranking among providers (e.g. hospitals in top 2 performing quartiles are offered increases in tariff payments)

• Absolute: incentives is paid for a continuous gradient of quality improvement (e.g. sickness funds receive higher payments for each patient enrolled in disease management program)

7. Size

• Amount of money provided or withdrawn

8. Certainty

• Certain: incented entity is certain about achievability of targets (e.g. targets seem easily achievable; guaranteed reward schedule)

• Uncertain: incented entity is uncertain about achievability of targets (e.g. targets seem not easily achievable; competition for limited funds)

9. Frequency and duration

• Frequency: number of times a year an incentive is provided

• Duration: number of years an incentive is provided

de Bruin et al. BMC Health Services Research 2011 11:272   doi:10.1186/1472-6963-11-272