The Effects of Performance Based Supplementary Payment on Physician Practice; A Cross Sectional Questionnaire Study

Aim: The aim of this study is to assess the effects of performance based supplementary payment (PBP) on work conditions, relations among health workers, income level, and use of health care services. Method: In this cross sectional survey, 654 physicians who had been practicing for at least ten years filled in a questionnaire to obtain opinions on the PBP. Results: Mean age and standard deviation of the physicians were 43.26+/-6.8. In terms of relationship among physicians, 67.6 % reported 'negative effect' of PBP. In terms of solidarity and competition, 68.8% responded that PBP decreased solidarity, and 84.1% responded that PBP increased competition among health care workers. Of the subjects, 56.1% reported an increased work load during PBP. More than two third of physicians thought that performance method increased unnecessary procedures and overuse of the services. More than half of the subjects responded that waiting time for physical examination reduced, and 60.9% reported that spending time per examination also decreased. More than half of the physicians had negative opinion about the PBP, 70.2% implied a negative effect on peace at work. With regard to effect of PBP on social life, 44.8% responded 'no effect' while 40.7% responded 'negative effect', and 60.6% reported that holiday activities were affected negatively. Conclusion: Increased income level of physicians, and increased accessibility to health care are main positive effects of PBP. Great incentives with fixed low salary may cause increased overuse of health services, increased competitions, decreased solidarity, conflict among physicians, inefficient use of resources, loss of ethical values, and decreased quality of service.