Pay-for-performance programs in P4P programs Israeli sick funds.
OBJECTIVE
This paper aims to analyze the development of "pay-for-performance" (P4P) programs implemented by Israel's two largest sick funds, insuring 78 percent of the population.


METHODS
Analysis of the main features and their evolution over time, the observed outcomes and concerns related to implementing these programs.


RESULTS
Our analysis revealed that although implementation has been successful, both managers and physicians have voiced concerns regarding the effect of measuring clinical performance such as focusing attention on the measured areas while neglecting other areas, and motivating a statistical approach to patient care instead of providing patient-centered care.


CONCLUSIONS
The Israeli case provides an interesting example of nation-wide, long-term implementation of the pay-for-performance program. Therefore, it provides other countries with the opportunity to assess features that may facilitate successful implementation, as well as highlighting issues related to the outcomes of P4P programs.
Gross
Revital
R
Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel. revital@jdc.org.il
Elhaynay
Asher
A
Friedman
Nurit
N
Buetow
Stephen
S
D000288:Administrative Personnel; D001291:Attitude of Health Personnel; D017598:Efficiency, Organizational; D004649:Employee Incentive Plans / Q000458:organization & administration*; D006801:Humans; D007348:Insurance, Health; D007557:Israel; D009313:National Health Programs / Q000458:organization & administration*; D010820:Physicians; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000379:methods*