Identification of hospital pay for performance schemes' theoretical frameworks, design characteristics, factors potentially influencing success and development of reporting guidelines: a mixed-method study
File(s)
Author(s)
Car, Mate
Type
Thesis
Abstract
Background: Pay for performance is increasingly being introduced into health systems. Previous
research found conflicting results regarding the effectiveness of pay for performance.
Objectives: In this thesis, I focus on pay for performance for hospitals as institutions and aimed
to understand: (a) how and why pay for performance produces its effects, (b) what are the
mechanisms by which pay for performance is believed to result in its intended outcomes and (c)
to develop a framework for reporting of hospital pay for performance incentive schemes.
Methods: Drawing on the principles of realist review, I collected and summarised existing
literature on pay for performance.
Results: Analysing 143 papers, I found pay for performance is an umbrella term for a multitude
of interventions that differ significantly in their motivations, design used and outcome
expectations. The number of factors identified to influence pay for performance across many
studies was greater than reported by any single study, suggesting an unawareness of factors or
else inconsistent reporting of important factors which affect results and their interpretation.
I discovered a number of context-mechanism-outcome configurations for performance
incentive designs. I propose a set of reporting guidelines to improve the quality of reporting of
research on pay for performance in hospitals.
Conclusion: Pay for performance in the broadest sense represents paying to encourage a specific
performance pattern. Using this realisation and comparing to conventional payment systems, it
is evident that even they encourage performance patterns. Pay for performance is not the
perfect answer for every issue, but needs to be considered as one of the tools to achieve policy
objectives.
research found conflicting results regarding the effectiveness of pay for performance.
Objectives: In this thesis, I focus on pay for performance for hospitals as institutions and aimed
to understand: (a) how and why pay for performance produces its effects, (b) what are the
mechanisms by which pay for performance is believed to result in its intended outcomes and (c)
to develop a framework for reporting of hospital pay for performance incentive schemes.
Methods: Drawing on the principles of realist review, I collected and summarised existing
literature on pay for performance.
Results: Analysing 143 papers, I found pay for performance is an umbrella term for a multitude
of interventions that differ significantly in their motivations, design used and outcome
expectations. The number of factors identified to influence pay for performance across many
studies was greater than reported by any single study, suggesting an unawareness of factors or
else inconsistent reporting of important factors which affect results and their interpretation.
I discovered a number of context-mechanism-outcome configurations for performance
incentive designs. I propose a set of reporting guidelines to improve the quality of reporting of
research on pay for performance in hospitals.
Conclusion: Pay for performance in the broadest sense represents paying to encourage a specific
performance pattern. Using this realisation and comparing to conventional payment systems, it
is evident that even they encourage performance patterns. Pay for performance is not the
perfect answer for every issue, but needs to be considered as one of the tools to achieve policy
objectives.
Version
Open Access
Date Issued
2016-03
Date Awarded
2016-12
Copyright Statement
Attribution NoDerivatives 4.0 International Licence (CC BY-ND)
Advisor
MAJEED, AZEEM
Harris, Matthew
Publisher Department
School of Public Health
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)