The target users were 65 general practices and two health insurance companies in the South of the Netherlands. Based on this framework design choices were discussed in two panels of target users using an adapted Delphi procedure. Methodsįor the development of the P4P program a framework was used which distinguished three main components: performance measurement, appraisal and reimbursement. We developed a P4P program in which the target users were involved in decisions about the P4P methods. One may assume that involvement of health care professionals in the goal setting and methods of quality measurement and subsequent payment schemes may enhance their commitment to and motivation for P4P programs and therefore the impact of these programs. Current programs vary in the methods of performance measurement, appraisal and reimbursement. International interest in pay-for-performance (P4P) initiatives to improve quality of health care is growing.
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