Impact of Pay-for-performance Incentives for Contracted Family Doctor Service among Primary Healthcare Providers on Diabetes Care in China

Abstract

\n Background: As the first step towards building a gatekeeping system in China, the governments have introduced a contracted family doctor service (CFDS) policy in primary healthcare (PHC) facilities since 2016. The impact of performance-based salary (PBS) system incentive on performance remained unknown. This study was to examine the association between the PBS adding incentive for CFDS and the performance indicators of diabetes care. Methods: We conducted a cross-sectional study in 72 PHC facilities in 6 cities that piloted the CFDS, extracting 827 PHC health workers and 420 diabetes patients. The PHC health workers’ performance on delivery of diabetes care focused on the continuity and coordination of care. The outcome performance of diabetes care was measured by patients’ utilization of diabetes care and control of blood glucose reported by patients.Results: PHC health workers whose performance on contracted service was included in the overall performance assessment had 0.279 (95% CI 0.031-0.526) more score of the continuity of care, and had 92.6% (OR 1.926, 95% CI 1.160-3.197) higher likelihood of good coordination of care. PHC health workers whose performance linked with increased income were 168.1% (OR 2.681, 95% CI 1.502-4.788) and 78.0% (OR 1.780, 95% CI 1.220-2.597) more likely to have good continuity and coordination of care, respectively. The facility level analysis showed that additional one-point percentage of PHC health workers whose performance on contracted service was included in the overall performance assessment, and additional one-point percentage of whose performance assessment increased their income was associated with 7.192 (OR 8.192, 95% CI 1.903-35.266) times and 52.2% (OR 1.522, 95% CI 1.055-2.196) higher probability of having their patients with control of blood glucose. Additional one-point percentage of PHC health workers whose performance assessment increased their income was associated with 0.559 (95% CI 0.139-0.979) more score on patients’ utilization of diabetes care.Conclusions: Inclusion of the requirements on CFDS into the assessment criteria, and adding the incentives rewarding better performance on contracted family doctors into PBS system for PHC health workers were associated with better delivery process and outcome performance on diabetes care.