Tools of power: pay-for-performance in French and German health reforms

Abstract

PurposePay-for-performance (P4P) as an innovation for improved health care has been introduced in many health systems worldwide. The aim of this article is to apply and refine a specific theoretical angle for the analysis of these reforms, the theoretical frameworks of public policy instruments and programmatic actors, in order to highlight differences between countries.Design/methodology/approachThis analysis is based on a comparative case study of the introduction of P4P in France and Germany in the ambulatory sector for the period from 2007 until 2017. This included a literature review and semi-structured interviews with 23 actors between 2013 and 2015.FindingsThe introduction of a supposedly clear-cut policy instrument – P4P in health care – is distinctly shaped by the intertwined configuration of institutional architecture and the policy programme of key system actors. This can be understood as a continuation of long-term transformations, most importantly the increasingly direct influence of the state and a weakening of the representation of the medical profession, as well as an internal fragmentation of the latter.Originality/valueThis analysis illustrates the applicability of the policy instrument approach to the heath sector. In addition, the authors have applied the dual perspective of policy instruments and programmatic actors. Both proved complementary and appropriate for the study of a highly technical instrument such as P4P.

Considering the role of context when implementing government policies in hospitals: introduction of a prospective payment system for psychiatry

“…One aspect which emerged in the interviews was the focus of the PPS on processes rather than outcomes, contributing to the incompatibility of the system with routine care. Linking reimbursement to outcomes has been discussed for a number of years, referring to it as value-based healthcare (Porter and Lee, 2013) or pay-for-performance (Brunn, 2020). Although this could align the diverging interests of the different stakeholders (Porter and Guth, 2012), it is underscored that such systems are currently hindered by veto players in the federal system (Brunn, 2020).…”

Born in the USA? A Comparison of “Inspired” Health Care Reforms in Germany and France

“…The interviews were semi-structured so that questions could be modified during the interview to follow-up new ideas. Qualitative content analysis was performed based on the Framework Method, a pragmatic tool that is not aligned with a particular theoretical approach (Gale et al 2013;Brunn 2020b). The following paragraphs will introduce both health systems, provide the overall policy context, and outline the structure of the respective DMPs.…”

“…The comparison of Germany and France is characterized by many commonalities as well as several differences, which are presented in detail elsewhere (Brunn 2020b). In brief, the narrative about commonalities in the literature goes back to the work of Gøsta Esping-Andersen, for whom Germany and France belong to the conservative-corporatist type of welfare-state regimes (Esping-Andersen 1990).…”

Exploring the effectiveness of a P4P scheme from the perspective of Italian general practitioners: A replication study

“…It uses organisational techniques in order to reduce health care utilisation by increasing quality of care through promotion of provider adherence to good clinical practice. In this context, P4P has been proposed in primary care as a further innovation for improved chronic care by creating financial incentives for doctors to provide more appropriate care 44 …”

“…Germany is a country in which a proper P4P programme is not been introduced yet 44 . Health policy actors voice a growing demand for more patient‐centeredness and improved quality, especially in the field of chronic diseases.…”