Participating physician preferences regarding a pay-for-performance incentive design: a discrete choice experiment

OBJECTIVE: To determine whether the magnitude of incentives or other design attributes should be prioritized and the most important attributes, according to physicians, of the diabetes P4P (pay-for-performance) program design. DESIGN: We implemented a discrete choice experiment (DCE) to elicit the P4P incentive design-related preferences of physicians. PARTICIPANTS: All of the physicians (n = 248) who participated in the diabetes P4P program located in the supervisory area of the northern regional branch of the Bureau of National Health Insurance in 2009 were included. The response rate was ∼ 60%. RESULTS: Our research found that the bonus type of incentive was the most important attribute, followed by the incentive structure and the investment magnitude. CONCLUSIONS: Physicians may feel that good P4P designs are more important than the magnitude of the investment by the insurer. The two most important P4P designs include providing the bonus type of incentive and using pay-for-excellence plus pay-for-improvement.