Eghbali Mohammad Ebrahim, Gorji Hasan Abolghasem, Arabloo Jalal, Martini Mariano, Behzadifar Masoud, Pourasghari Hamid
Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.
J Prev Med Hyg. 2025 May 31;66(1):E126-E137. doi: 10.15167/2421-4248/jpmh2025.66.1.3497. eCollection 2025 Mar.
Providing quality healthcare services relies on capable physicians with high performance levels. A performance-based payment system can enhance physician productivity, clinical service quality, and patient satisfaction. This study aimed to design a performance-based payment model for physicians in outpatient clinics contracted with the Iran Health Insurance Organization, tailored to its specific context and structure.
The study employed a mixed-methods approach, combining quantitative and qualitative data collection and analysis. Through a literature review and expert interviews, 47 performance indicators and 18 selection criteria were identified. These indicators were reviewed in expert panels, and 49 questionnaires were used to prioritize them based on health insurance structures. The final indicators were categorized into current, transitional, and desired statuses, aligned with organizational infrastructures.
The study identified 24 key indicators, including 9 for general physicians and 13 for specialized physicians. These indicators covered aspects such as the average number of prescribed medications, electronic prescription usage, per capita diagnostic procedures, timely physician presence, patient complaints, work history, guideline adherence, electronic record completion, patient satisfaction, training participation, and test prescription rates. Each indicator was detailed with a title, formula, standard, data collection method, and source.
The proposed performance-based payment model, utilizing the selected indicators, can guide physicians toward achieving organizational goals such as cost reduction, process efficiency, and improved patient satisfaction. By clarifying expe tations and assessing various performance dimensions, the model provides a framework for enhancing physician performance and aligning it with the objectives of the Health Insurance Organization. Policymakers can use this model to drive systemic improvements in healthcare delivery.
提供高质量的医疗服务依赖于具备高水平表现的能干医生。基于绩效的支付系统可以提高医生的生产力、临床服务质量和患者满意度。本研究旨在为与伊朗健康保险组织签约的门诊医生设计一种基于绩效的支付模式，使其适合该组织的特定背景和结构。
本研究采用混合方法，结合定量和定性数据的收集与分析。通过文献综述和专家访谈，确定了47个绩效指标和18个选择标准。这些指标在专家小组中进行了审查，并使用49份问卷根据健康保险结构对其进行优先级排序。最终指标根据组织基础设施分为当前、过渡和期望状态。
该研究确定了24个关键指标，其中包括9个普通医生指标和13个专科医生指标。这些指标涵盖了诸如处方药物平均数量、电子处方使用情况、人均诊断程序、医生按时出诊、患者投诉、工作经历、遵循指南情况、电子记录完成情况、患者满意度、培训参与情况以及检查处方率等方面。每个指标都详细列出了标题、公式、标准、数据收集方法和来源。
所提出的基于绩效的支付模式利用选定的指标，可以引导医生实现诸如成本降低、流程效率提高和患者满意度提升等组织目标。通过明确期望并评估各种绩效维度，该模式为提高医生绩效并使其与健康保险组织的目标保持一致提供了一个框架。政策制定者可以使用这个模式来推动医疗服务的系统性改进。
