Goals and Effects of “Iranian Pay for Performance” Program for Non-Medical Workforce in Teaching Hospitals: Qualitative Study

Goals and Effects of “Iranian Pay for Performance” Program for Non-Medical Workforce in Teaching Hospitals: Qualitative Study Serajaddin Gray1, Mohammad Aghajani2, Razieh Ronasian3, Saeed Manavi4, Iraj Harirchi5, Alireza Olyaee Manesh1, 6, *, Mani Yousefvand1, Seyedeh Hosnieh Shafaee Tonekaboni3, Pejman Hamouzadeh1, Farhad Habibi Nodeh7 1Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 2 MD. Chancellor, Shahid Beheshti University of Medical Sciences, Tehran, Iran 3Expert of National Program of Pay for Performance, Ministry of Health and Medical Education, Tehran, Iran 4Head of National Program of Pay for Performance, Ministry of Health and Medical Education, Tehran, Iran 5 Department of Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 6Group of Payment and Financial Resources of the Health, National Institute of Health Research, Tehran, Iran 7 Ph.D. Health Care Management, Dept. of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Abstract Introduction: The design of each pay mechanism, theoretically, affects the behavior of providers and creates different responses. This study is a survey of the new Iranian performance-based payment method for the hospital staff (Recommendation 2014) and its possible effects on the behavior of staff and hospitals. Methods: A qualitative study was conducted at two national and provincial levels using a documentary review, taking notes in meetings, and individual interviews (13 people at the ministry, university, and hospital levels). Content analysis was performed using MAXQDA V. 10 software, and the extraction of codes was thematic. Results: Aligning staff individual objectives with organizational performance; decentralization in employee administration; more predictability of staff costs; motivating to take care of more patients; reducing incentives for induced demand and insurance deductions; effect of three groups of individual, work-related, and functional factors on individual pay and gathering accurate information about the amount paid to employees in the country are the goals and potential positive effects of the program. Complexity, reciprocity of the program, postponement of payment to employees, and lack of transparency in the insurance deductions of each department were program problems. Conclusion: Potentially, this program provides the right tools to meet the desired goals, however, it depends on the capacity of the executive directors. The postponement of employee payments is the biggest threat to the effects of this program. Keywords: Reimbursement Mechanisms; Prospective Payment System; Public Hospitals; Health Manpower; Iranian Pay for Performance Please cite this article as follows: Gray S, Aghajani M, Ronasian R, et al. Goals and Effects of “Iranian Pay for Performance” Program for Non-Medical Workforce in Teaching Hospitals: Qualitative Study. Hakim Health Sys Res, 2019 22(2): 82-93. *Corresponding Author: Group of Payment and Financial Resources of the Health, National Institute of Health Research, Bozorgmehr St., Postal Code: 1416833481, Tehran, Iran. Tel: +98-2166407822, Fax: +98-2166489092, Email: [email protected]