Intrinsic and extrinsic motivations in primary care: An explanatory study among French general practitioners

Money Talks - Paying Physicians for Performance

“…Sicsic et al (2012) report a potentially negative relationship between intrinsic and extrinsic motivation for French general practitioners noting that policy makers should be aware that P4P incentives could lead to a corrosion of intrinsic motivation. Campbell et al (2009) and Doran et al (2011) document that P4P incentives lead to a decline in the quality of non-incentivized dimensions of care.…”

Impact assessment of a pay-for-performance program on breast cancer screening in France using micro data

“…In a comparable study, Kiran et al [15] focused specifically on breast cancer screening and concluded that the P4P scheme targeting GPs was associated with little or no improvement in screening rates despite substantial expenditures. Other studies have suggested potential unintended consequences of financial incentives, particularly the crowding out of doctors' intrinsic (non-financial) motivations by extrinsic (financial) rewards [17][18][19], which might contribute to explaining the low impact of P4P on GPs' prevention activities.…”

Brazil's National Program for Improving Primary Care Access and Quality (PMAQ)

“…Because of its scale and the heterogeneity among Brazil's 5700 municipalities, the program has great potential to inform larger questions about the impact of financial incentives on quality within the context of a public health service in a middle-income country. There are opportunities as well to assess ongoing debates over whether it is the financial mechanism or another mechanism such as comparison among peers that may drive performance improvement (Sicsic et al, 2012). Finally, international experiences show that it is important to be vigilant about avoiding unintended effects.…”

“…In primary care, pay for performance has been implemented alone and in combination with a number of other approaches such as provider training through internships and residencies in specific primary care areas (family medicine, internal medicine, and pediatrics), other forms of certification such as provider licensure, and in-service training including detailing and continuing education of providers at each level (McDonnell et al, 2012; Talbot et al, 2009); electronic medical records and screening protocols including methods to enhance standardized prescribing of medications (Campbell et al, 2010; Fernandez et al, 2013); case management techniques, including coordination of care especially for individuals with complex or multiple health needs (Griffin et al, 2004; Joo & Huber, 2012); task shifting (Harris & Haines, 2012); and management techniques to modify the way providers are paid, including developing more collaborative supervision, goal setting, and continuous quality improvement initiatives (Pinheiro et al, 2009; Sicsic et al, 2012). …”