Design and implementation of pay-for-quality in primary healthcare

摘要

Background The common methods of payment to healthcare providers such as capitation and salary are not designed to be stimulation for high quality healthcare. The pay-for -quality (P4Q) programs are designed to provide the financial incentives to the service providers in order to improve quality of services based on specified criteria. Aims This study describes the design and implementation of a P4Q program in the primary healthcare (PHc) in East Azerbaijan Province, Iran. Methods The present study is a case study that describes the process of designing and implementing the P4Q program in PHC in East-Azerbaijan province in 2015. To design the P4Q program, after identifying core components of the program through literature review and Focus Group Discussion (FGD), final decision about each component was made by achieving consensus from a panel of recognised experts in the area of PHc. Altogether two FGD and seven expert panel sessions were hold in EAPHC in order to design the P4Q program. Results Key components of P4Q program were selected by qualitative studies and the results were categorized in five headings including P4Q formula, quality measures, payment strategy, data reporting and performance evaluation. The formula consists of five elements including fixed payment, individual, team and organization performance and managerial appraisal. A total of 37 measures, which covers the domains of quality of PHc, human resource development and responsibility were selected. 'Improvement' and 'absolute level of measures' were selected as the payment strategy. The methods of data reporting included valid questionnaire, organization’s documents and medical records. The final P4Q program was used for paying incentives to all primary health care providers in public health centres affiliated to Tabriz University of Medical Sciences. Conclusion Designing and implementing the P4Q program led to a shift in paying the incentives to healthcare providers from passiveness and subjective judgment to rational and quality based payment. Linking the incentive payment to individual, team, and organizational performance, the P4Q program will lead to an increased capacity of staff morale to improve teamwork and integrated health care.