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

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.

Experiences of general practices with a participatory pay-for-performance program: a qualitative study in primary care.

The involvement of target users in the design choices of a pay-for-performance program may enhance its impact, but little is known about the views of participants in these programs. To explore general practices' experiences with pay-for-performance in primary care we conducted a qualitative study in general practices in the Netherlands. Thirty out of 65 general practices participating in a pay-for-performance program, stratified for bonus, were invited for a semistructured interview on feasibility, feedback and the bonus, spending of the bonus, unintended consequences, and future developments.

Design choices made by target users for a pay-for-performance program in primary care: an action research approach.

Background: International interest in pay-for-performance (P4P) initiatives to improve quality of health care is growing. Current programs vary in the methods of performance measurement, appraisal and reimbursement. One may assume that involvement of health care professionals in the goal setting and methods of quality measurement and subsequent payment schemes may enhance their commitment to and motivation for P4P programs and therefore the impact of these programs.

Improving access to primary care: the impact of a quality-improvement strategy.

Problem: Many patients are not satisfied with the accessibility and availability of general practice, and they would like to see improvement.

Design: Quality-improvement study with pre-intervention and post-intervention data collection in 36 general practices.

Setting: General practices located in the south of The Netherlands.