title: Would German physicians opt for pay-for-performance programs? A willingness-to-accept experiment in a large general practitioners' sample.
abstract: BACKGROUND
  Implementing pay-for-performance (P4P) programs is a non-trivial task. As evaluation studies showed, P4P programs often failed to improve performance quality. A crucial element for the successful implementation of P4P is to gain acceptance with health care providers.
  
  
  OBJECTIVE
  The aim of our study was to determine, if (and at what bonus rate) German general practitioners (GPs) would participate in a P4P program. We further examined differences between respondents who would participate in a P4P program (participants) versus respondents who would not participate (non-participants).
  
  
  METHODS
  A mail survey was conducted among 2493 general practitioners (GPs) in Lower Saxony (with a response rate of 36.2%). The questionnaire addressed attitudes toward P4P and included a willingness to accept experiment concerning P4P implementation.
  
  
  RESULTS
  The participation rate increased from 28% (at a bonus of 2.5%) to 50% (at a bonus of 20%). Participants showed better performance in target achievement and expected higher gains from P4P than non-participants. Major attitude differences were found in assessing feasibility of P4P, incentivizing performance and unintended consequences. The crucial factor for (not) accepting P4P might be the sense of (un)fairness of P4P.
  
  
  CONCLUSIONS
  To convince GPs to participate in P4P, better evidence for the effectiveness of P4P is required. To address the concerns of GPs, future endeavors should be directed to tailoring P4P programs. Finally, program implementation must be well communicated and thoroughly discussed with health care providers.
authors: Hannover Medical School, Center for Health Economics Research Hannover (CHERH), Carl-Neuberg-St. 1, 30625 Hanover, Germany. Electronic address: krauth.christian@mh-hannover.de.
authors: Christian
authors: C
authors: Krauth
authors: Hannover Medical School, Center for Health Economics Research Hannover (CHERH), Carl-Neuberg-St. 1, 30625 Hanover, Germany.
authors: Sebastian
authors: S
authors: Liersch
authors: Hannover Medical School, Center for Health Economics Research Hannover (CHERH), Carl-Neuberg-St. 1, 30625 Hanover, Germany.
authors: Sören
authors: S
authors: Jensen
authors: Hannover Medical School, Center for Health Economics Research Hannover (CHERH), Carl-Neuberg-St. 1, 30625 Hanover, Germany.
authors: Volker Eric
authors: VE
authors: Amelung
mesh_terms: D000553:Ambulatory Care; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000523:psychology*; D012052:Reimbursement, Incentive; D011795:Surveys and Questionnaires
keywords: Ambulatory care; Contingent valuation; Germany; Pay-for-performance; Willingness to accept