Developing a Model of Pay for Performance in Primary Health Care: The Case of East Azerbayjan Health Centers

Abstract

Abstract Introduction: Pay-For-Performance (P4P) is an effective strategy to improve quality of healthcare and performance of healthcare providers. Objective: The aim of this study was to design a P4P model to improve the incentive payments to primary healthcare providers and achieve improvements in healthcare related outcomes. Methods : This study is an action research conducted from 1394 to 1396. At first step using systematic review, quality quantitative methods P4P model was designed and piloted in 3 district health networks in Tabriz. P4P program was evaluated trough short satisfaction questionnaire and before-after intervention analysis. Results: P4Q was considered as the focus of intervention.139 individual measures and 41 team/organizational measures were selected. "Achievement of measures' targets" and "improvement of measures" were selected as payment strategies. The most and least satisfaction rate was related to improvement of providers' performance (53% (n=80)) and fairness in payments (37% (56)), respectively. Regarding the performance of Behvarzes approximately 19% (23.04) improvements in risk factors' screening measure, 13% (15.12) improvement in maternity care measure, 11% (11.88) improvement in child-healthcare coverage and 8% (12.41) improvement in school-students' healthcare measure were observed. Regarding the performance of primary health care provider approximately 13% (25.76) improvement in child-healthcare coverage measure and 12% (19.56) improvement in aged care coverage measure were observed. Regarding the performance of physician approximately 15% (15.29) improvement in HbA1c control and 29% (17.40) improvement in LDL control measure was achieved. Regarding the performance of health centers approximately 10% (21.97) improvement in mean performance score was observed. However, the intervention did'nt have significant effect on organizational performance. Conclusion: Designing and implementing the P4P program with respect to local health priorities led to the improvement of individual and team performance of healthcare providers in health centres.