Physicians' views on pay-for-performance as a reimbursement model: a quantitative study among Dutch surgical physicians

K.M. Alqasim*, E.N. Ali, S.M.A.A. Evers, M. Hiligsmann

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review



To assess the views, knowledge, and experience of Dutch physicians with regard to the general objectives and values of the pay-for-performance (P4P) system, as the Dutch healthcare industry might find it useful, in terms of governance, to explore this approach further.


A quantitative cross-sectional survey study was conducted among 48 physicians in surgical specialties in the Netherlands between May 2014 and July 2014. The survey questionnaire was designed to gather information regarding the intensity of feelings, on a 7-point Likert scale, toward statements that address the P4P system. Confidence intervals were calculated using the bootstrap technique with 1000 iterations.


Physicians see a positive value in P4P for their organizations rather than for personal attainment (mean=5.00; 95% CI=4.62-5.39), even though they feared that P4P might put financial pressure on them (mean=5.03; 95% CI=4.50-5.54). They strongly share the view that other colleagues will resist adopting P4P as a business model (mean=5.74; 95% CI=5.43-6.04). Respondents stated that they would not leave their current jobs if P4P were to be incorporated in their organization.


Physicians see value in P4P for their organizations, and consider that P4P could provide an incentive for improving medical outcomes. There seems to be potential for the P4P system in the Netherlands as participants expressed positive support for its values. There is an intersection of interests between the value of P4P and the physicians' aim of achieving quality outcomes; however, further studies would be needed to investigate perceptions about specific design features in a larger sample. In addition, prior to implementing P4P, broad education about the system should be provided in order to counteract pre-conceptions and prevent resistance.

Original languageEnglish
Pages (from-to)158-167
Number of pages10
JournalJournal of Medical Economics
Issue number2
Publication statusPublished - 1 Feb 2016


  • P4P
  • Pay-for-performance
  • Quality indicators
  • Performance indicators
  • Reimbursement
  • Incentives

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