The Ministry of Health of Turkey introduced performance-based supplementary payment (PBSP) system in 2004. The importance of feedbacks from healthcare providers regarding the implementation of alternative health policies has been recognized in the literature. This study reports the perceptions of physicians about the PBSP system in Turkey. A qualitative analysis has been conducted in two hospitals in the Western province of Turkey, Balıkesir. Analysis results suggest that physicians have limited awareness about the pay for performance system. They agree that the PBSP system has not achieved the objectives of enhancing productivity, efficiency and quality of care. The major contributing factors to the limited success of the system have been identified as increased workload, stress and competition among the physicians. Thus revisions have been suggested for the proper implementation of the programme, which include the determination of a maximum number of medical examinations.
ArmourB.S.FriedmanC.PittsM.M.WikeJ.AlleyandL.EtchasonJ. (2004). The influence of year-end bonuses on colorectal cancer screening. American Journal of Managed Care, 10(9), 617–24.
2.
CasalinoL.P.AlexanderG.C.JinL.KonetzkaR.T. (2007). General internists’ views on pay-for-performance and public reporting of quality scores: A national survey. Health Affairs, 26(2), 492–9.
3.
ChandlerC.I.ChonyaS.MteiF.ReyburnH.WhittyC.J. (2009). Motivation, money and respect: A mixed-method study of Tanzanian non-physician clinicians. Social Science & Medicine, 68(11), 2078–88.
4.
ChristiansonJ.B.WarrickL.H.WholeyD.R. (2005). Physicians’ perceptions of managed care: A review of the literature. Medical Care Research and Review, 62(6), 635–75.
5.
EgglestonK. (2005). Economic modeling of methods to stimulate quality improvement. International Journal for Quality in Health Care, 17(6), 521–31.
6.
EttnerS.L.SchoenbaumM. (2006). The role of economic incentives in improving the quality of mental health care. In JonesA.M. (Ed.) The elgar companion to health economics (pp. 286–95). Cheltenham, UK: Edward Elgar.
7.
FitzpatrickR.BoultonM. (1994). Qualitative methods for assessing health care. Quality in Health Care, 3(2), 107–13.
8.
ForrestC.B.VillagraandV.V.PopeJ.E. (2006). Managing the metric vs. managing the patient: The physician’s view of pay for performance. American Journal of Managed Care, 12(2), 83–5.
9.
FrancoL.M.BennettS.KanferR. (2002). Health sector reform and public sector health worker motivation: A conceptual framework. Social Science & Medicine, 54(8), 1255–66.
GoetzK.CampbellS.M.SteinhaeuserJ.BrogeB.WillmsS.SzecsenyiJ. (2011). Evaluation of job satisfaction of practice staff and general practitioners: An exploratory study. BMC Family Practice, 12(1), 137.
13.
GreeneR.A.BeckmanH.ChamberlainJ.PartridgeG.MillerM.BurdenD. (2004). Increasing adherence to a community-based guideline for acute sinusitis through education, physician profiling, and financial incentives. American Journal of Managed Care, 10(10), 670–8. [PMID: 15521158]
14.
HalbeslebenJ.R.RathertC. (2008). Linking physician burnout and patient outcomes: Exploring the dyadic relationship between physicians and patients. Health Care Management Review, 33(1), 29–39.
15.
HarrisR.V.DancerJ.M.MontasemA. (2011). The impact of changes in incentives and governance on the motivation of dental practitioners. The International Journal of Health Planning and Management, 26(1), 70–88.
16.
HillmanA.L.RipleyK.GoldfarbN.NuamahI.WeinerJ.LuskE. (1998). Physician financial incentives and feedback: Failure to increase cancer screening in Medicaid managed care. American Journal of Public Health, 88(11), 1699–1701.
17.
HillmanA.L.RipleyK.GoldfarbN.WeinerJ.NuamahI.LuskE. (1999). The use of physician financial incentives and feedback to improve pediatric preventive care in medicaid managed care. Pediatrics, 104 (part 1), 931–5.
18.
IchniowskiC.ShawK. (2003). Beyond incentive pay: Insiders’ estimates of the value of complementary human resource management practices. The Journal of Economic Perspectives, 17(1), 155–80.
19.
KaczorowskiJ.GoldbergO.MaiV. (2011). Pay-for-performance incentives for preventive care views of family physicians before and after participation in a reminder and recall project (P-PROMPT). Canadian Family Physician, 57(6), 690–6.
20.
KleinJ.FrieK.G.BlumK.KnesebeckO. von dem (2011). Psychosocial stress at work and perceived quality of care among clinicians in surgery. BMC Health Services Research, 11(1), 109.
21.
LeeJ.Y.LeeS.I.JoM.V. (2012). Lessons from healthcare providers’ attitudes toward pay-for-performance: What should purchasers consider in designing and implementing a successful program?Journal of Preventive Medicine and Public Health, 45(3), 137–47.
22.
Levin-ScherzJ.DeVitaN.TimbleJ. (2006). Impact of pay-for-performance contracts and network registry on diabetes and asthma HEDIS measures in an integrated delivery network. Medical Care Research and Review, 63(1), 14S–28S.
23.
LockeR.G.SrinivasanM. (2008). Attitudes toward pay-for-performance initiatives among primary care osteopathic physicians in small group practices. JAOA: Journal of the American Osteopathic Association, 108(1), 21–4.
24.
McDonaldR.RolandM. (2009). Pay for performance in primary care in England and California: Comparison of unintended consequences. The Annals of Family Medicine, 7(2), 121–7.
25.
McNabbR.WhitfieldK. (2007). The impact of varying types of performance-related pay and employee participation on earnings. The International Journal of Human Resource Management, 18(6), 1004–25.
26.
MurphyK.M.NashD.B. (2008). Nonprimary care physicians’ views on office-based quality incentive and improvement programs. American Journal of Medical Quality, 23(6), 427–39.
27.
RobinsonJ.C. (2001). Theory and practice in the design of physician payment incentives. Milbank Quarterly, 79(2), 149–77.
28.
RosenthalM.B.FrankR.G.LiZ.EpsteinA.M. (2005). Early experience with pay-for-performance. JAMA: The Journal of the American Medical Association, 294(14), 1788–93.
29.
SahinI.OzcanY.A.OzgenH. (2011). Assessment of hospital efficiency under health transformation program in Turkey. Central European Journal of Operations Research, 19(1), 19–37.
30.
SargentM.C.SotileW.SotileM.O.RubashH.BarrackR.L. (2004). Stress and coping among orthopaedic surgery residents and faculty. The Journal of Bone and Joint Surgery (American), 86(7), 1579–86.
31.
ShanafeltT.D.WestC.ZhaoX.NovotnyP.KolarsJ.HabermannT.. (2005). Relationship between increased personal well being and enhanced empathy among internal medicine residents. Journal of General Internal Medicine, 20(7), 559–64.
32.
SulkuS.N. (2012). The health sector reforms and the efficiency of public hospitals in Turkey: Provincial markets. The European Journal of Public Health, 22(5), 634–8.
33.
TelekiS.S.DambergC.L.PhamC.BerryS.H. (2006). Will financial incentives stimulate quality improvement? Reactions from frontline physicians. American Journal of Medical Quality, 21(6), 367–74.
34.
Van HerckP.SmedtD. DeAnnemansL.RemmenR.RosenthalM.B.SermeusW. (2010). Systematic review: Effects, design choices, and context of pay-for-performance in health care. BMC Health Services Research, 10(1), 247.
35.
WallaceJ.E.LemaireJ.B.GhaliW.A. (2009). Physician wellness: A missing quality indicator. The Lancet, 374(9702), 1714–21.
36.
WeyerS.M.BobiakS.StangeK.C. (2008). Possible unintended consequences of a focus on performance: Insights over time from the research association of practices network. Quality Management in Healthcare, 17(1), 47–52.
37.
WharamJ.F.Paasche-OrlowM.K.FarberN.J.SinskyC.RuckerL.RaskK.J. (2009). Internal medicine policy analysis. Journal of General Internal Medicine, 24(7), 854–9.
38.
YasarG.Y. (2011). Health transformation programme in Turkey: An assessment. The International Journal of Health Planning and Management, 26(2), 110–33.
39.
YildirimJ.OcalN.EruygurO.YilmazE. (2011). The mathematical modelling of performance based supplementary payment system in Turkish health sector. Sağlık Düşüncesive Tıp Kültürü Dergisi, 19(Summer), 52–5.
40.
YoungG.J.MeterkoM.WhiteB.BokhourB.G.SautterK.M.BerlowitzD.. (2007). Physician attitudes toward pay-for-quality programs perspectives from the front line. Medical Care Research and Review, 64(3), 331–43.
