Incentives for physician teams: Effectiveness of performance feedback and payment distribution methods |
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| Affiliation: | 1. Department of Business Management, National Sun Yat-sen University, No.70 Lien-Hai Rd., Kaohsiung 804, Taiwan;2. Research Center for Epidemic Prevention, National Yang Ming Chiao Tung University, No.155, Sec. 2, Li‑Nong Street, Taipei 112, Taiwan;3. Department of Economics, Syracuse University, 900 South Crouse Ave. Syracuse, NY 13244, USA;4. Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, No.155, Sec. 2, Li‑Nong Street, Taipei 112, Taiwan;5. National Health Insurance Administration, Ministry of Health and Welfare, No.140, Sec.3, Hsinyi Rd., Taipei 106, Taiwan;1. National Research Council-Neuroscience Institute, Aging Branch, Via Vincenzo Maria Gallucci 16, 35128 Padova, Italy;2. Geriatrics Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani 2, 35128 Padova, Italy;3. Geriatric Unit, Department of Medical Sciences, University of Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy;4. Unit of Geriatrics, Department of Medicine, Biomedical Campus of Rome, via Alvaro del Portillo, 21, 00128 Rome, Italy;5. Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Viale Peraccini 18, 50139 Florence, Italy;6. National Research Council-Institute of Biomedical Technologies, Epidemiology Unit, Via Fratelli Cervi 93, 20090 Segrate, Italy;7. National Research Council-Institute of Clinical Physiology, Epidemiology and Health Research Laboratory, Via G. Moruzzi 1, 56124 Pisa, Italy;8. Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, Università di Milano, ASST Fatebenefratelli Sacco, 20157 Milan, Italy;9. National Research Council-Institute of Clinical Physiology, Department of Environmental Epidemiology and Disease registries, Via G. Moruzzi 1, 56124 Pisa, Italy;10. Division of Infectious Diseases, Azienda Ospedaliero Universitaria Ospedali Riuniti, Via Conca, 71, 60020, Ancona, Italy;1. Department of Health Management an Economy, Faculty of Medicine, University of Oslo and Oslo University Hospital Comprehensive Cancer Centre, Norway;2. Department of Clinical Medicine, Faculty of Medicine, University of Oslo and Division of Cancer Medicine, Oslo University Hospital Comprehensive Cancer Centre, Norway;1. Centre for Primary Care and Health Services Research, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK;2. Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland |
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| Abstract: | Best practices in team-based incentive design remain underexplored. This study examines under group-based pay-for-performance, how managers incentivize physicians for teamwork through internal feedback and payment distribution methods. In collaboration with Taiwan Association of Family Medicine, authors conducted a national survey of physician groups, with a response rate of 48.3%. Multilevel linear regression was applied to 134 groups, collectively consisting of 1,245 physicians in Taiwan. The outcome variables were two manager-rated scores for group performance on achieving (a) comprehensive, coordinated, continuous care, and (b) patient health improvement. The results indicate that providing each physician feedback on peer performance is superior to not providing it; when providing peer information within a group, concealing identities is superior to revealing them. These findings imply that application of the principle of social comparison can be effective; however, caution should be taken when disclosure of identifiable peer performance may intensify peer competition and undermine care coordination in team-based models. Further, groups that distribute payments equally among physicians perform better than groups that distributed payment proportionally to physicians’ patient shares. The findings are germane to small teams, where physicians do not have full control over care processes and outcomes, and need to work cooperatively to maximize group-based payment. |
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