title: Perceptions and experiences of financial incentives: a qualitative study of dialysis care in England.
abstract: OBJECTIVE
  The objective of the study was to understand the extent to which financial incentives such as Payment by Results and other payment mechanisms motivate kidney centres in England to change their practices.
  
  
  METHODS
  The study followed a qualitative design. Data collection involved 32 in-depth semistructured interviews with healthcare professionals and managers, focusing on their subjective experience of payment structures.
  
  
  METHODS
  Participants were kidney healthcare professionals, clinical directors, kidney centre managers and finance managers. Healthcare commissioners from different parts of England were also interviewed.
  
  
  METHODS
  Participants worked at five kidney centres from across England. The selection was based on the prevalence of home haemodialysis, ranging from low (<3%), medium (5-8%) and high (>8%) prevalence, with at least one centre in each one of these categories at the time of selection.
  
  
  RESULTS
  While the tariff for home haemodialysis is not a clear incentive for its adoption due to uncertainty about operational costs, Commissioning for Quality and Innovation (CQUIN) targets and the Best Practice Tariff for vascular access were seen by our case study centres as a motivator to change practices.
  
  
  CONCLUSIONS
  The impact of financial incentives designed at a policy level is influenced by the understanding of cost and benefits at the local operational level. In a situation where costs are unclear, incentives which are based on the improvement of profit margins have a smaller impact than incentives which provide an additional direct payment, even if this extra financial support is relatively small.
authors: Imperial College Business School, South Kensington Campus, London, UK.
authors: Inger
authors: I
authors: Abma
authors: Anuradha
authors: A
authors: Jayanti
authors: Steffen
authors: S
authors: Bayer
authors: Sandip
authors: S
authors: Mitra
authors: James
authors: J
authors: Barlow
mesh_terms: D004739:England; D006437:Hemodialysis, Home / Q000191:economics*; D006801:Humans; D007407:Interviews as Topic; D009042:Motivation; D036301:Qualitative Research; D012052:Reimbursement, Incentive; D051437:Renal Insufficiency / Q000628:therapy*; D013222:State Medicine