Volume 24, Issue 3 (10-2021)                   jha 2021, 24(3): 43-55 | Back to browse issues page

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Mohammadi M, Yousefi M, Mohammadi A, Pourahmadi E, Ebrahimipour H, Malek Sadati S. The effect of pay for performance on income inequality between medical and non-medical staff. jha 2021; 24 (3) :43-55
URL: http://jha.iums.ac.ir/article-1-3735-en.html
1- M.Sc., Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
2- Associate professor, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. , yousefimh@mums.ac.ir
3- PhD Student, Faculty of Health, Tehran University of Medical Sciences, Tehran, Iran.
4- Professor, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
5- Assistant professor, School of Economics and Administration, Ferdowsi University of Mashhad, Mashhad, Iran.
Abstract:   (1540 Views)
Introduction: Human resources are the most important asset of any organization; also, the payment system is the main motivating factor for hospital staff. The aim of this study is to evaluate the effect of implementing pay for performance (P4P) instruction on inequality in income distribution between medical and non-medical staff.
Methods: The present study is a applied research study conducted through a descriptive method. The statistical population of the study, hospitals, and P4P were selected from Mashhad University of Medical Sciences, Iran. Data on personnel characteristics and their income were also collected for three periods including a six-month pre-implementation period, as well as two six-month post-implementation P4P periods. Meanwhile, we used Lorenz curve and Gini coefficient to measure inequality in the distribution of income.
Results: The Gini coefficient obtained for all employees has increased from 63% for the period before the implementation of the instruction to 62% in the second period and 65% in the third period after the implementation of the instruction. The Gini coefficient between the physicians group and the nurses group for the first period was 64 and 35%; for the second period 61 and 25%; and for the third period 62 and 26%.
Conclusion: Results of this study are expected to be applied to reform current P4P policies in hospital. However, schemes that cause the service compensation change need to be examined from different dimensions; one of which is the impact on income inequality that requires more comprehensive studies.
Full-Text [PDF 1113 kb]   (742 Downloads)    
Type of Study: Research | Subject: Health Economics
Received: 2021/06/27 | Accepted: 2021/09/21 | Published: 2021/11/28

1. Yousefi M, Ahmadi M, Fazaeli S. Staff management based on performance: Application of a work measurement model in hospital. Payavard Salamat. 2014;8(1):79-89. [In Persian]
2. Correia T, Dussault G, Pontes C. The impact of the financial crisis on human resources for health policies in three southern-Europe countries. Health Policy. 2015 Dec;119(12):1600-5. [DOI:10.1016/j.healthpol.2015.08.009]
3. Lombarts KM, Plochg T, Thompson CA, Arah OA, Consortium DP. Measuring professionalism in medicine and nursing: Results of a European survey. PLoS One. 2014 May;9(5):1-12. [DOI:10.1371/journal.pone.0097069]
4. Yousefi M, Aliani S, Valinejadi A, Rezazadeh A, Khorsand A, Fazaeli S, et al. Effect of" Iran's health system evolution plan" and" tariff change" on financial performance of para-clinic units in a big tertiary hospital in Iran. Koomesh. 2018;20(2):403-9. [In Persian]
5. Glied SA, Ma S, Pearlstein I. Understanding pay differentials among health professionals, nonprofessionals, and their counterparts in other sectors. Health Aff. 2015 Jun;34(6):929-35. [DOI:10.1377/hlthaff.2014.1367]
6. Brown MP. The effect of nursing professional pay structures and pay levels on hospitals' heart attack outcomes. Health Care Manage Rev. 2006;31(3):241-50. [DOI:10.1097/00004010-200607000-00010]
7. Khosravani M, Abedi HA, Lak S, Rafiei F, Rahzani K. The association between conscience understanding and clinical performance among nurses working at education hospital of Arak. Ann Trop Med Public Health. 2017 Jan;10(6):1587-90. [DOI:10.4103/ATMPH.ATMPH_533_17]
8. Mohammadpour S, Niknam N, Javan-Noughabi J, Yousefi M, Ebrahimipour H, Haghighi H, et al. The factors associated with direct medical costs in patients with gastric cancer: Quantile regression approach compared with gamma regression. Value Health Reg Issues. 2020 May;21:127-32. [DOI:10.1016/j.vhri.2019.08.479]
9. Shahabi M, Tofighi Sh, Maleki MR. The nurse and specialist physicians manpower distribution by population and its relationship with the number of beds at public hospitals in Iran's 2001-2006. Journal of health administration. 2010;13(41):7-14. [In Persian]
10. Jalali FS, Jafari A, Bayati M, Bastani P, Ravangard R. Equity in healthcare financing: A case of Iran. Int J Equity Health. 2019 Jun;18(92):1-10. [DOI:10.1186/s12939-019-0963-9]
11. Raeisi P, Alikhani M, Mobinizadeh MR. Fee for service (FFS) payment on the basis of performance in Hasheminejad hospital, Tehran. Journal of Healthcare Management. 2010;2(1-2):27-36. [In Persian]
12. Mahdavi-Mazdeh M, Zamani M, Zamyadi M, Rajolani H, Tajbakhsh K, Heidary Rouchi AR, et al. Hemodialysis cost in Tehran, Iran. Hemodial Int. 2008 Oct;12(4):492-8. [DOI:10.1111/j.1542-4758.2008.00313.x]
13. Ebrahimipour H, Olyani S, Rezazadeh AR, Khorsand Vakilzadeh A, Fazaeli S, Jafari M, et al. Effect of" Iran's health system evolution" and" tariff change" based on relative values book on performance of obstetrics and gynecology department: A case study in a big hospital. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2017 Oct;20(8):15-25. [In Persian]
14. Wang Z, Wang J. Reimbursement policy in a healthcare system with priorities: Fee for priority versus bundled priority. IMA J Manag Math. 2021 Jul;32(3):329-60. [DOI:10.1093/imaman/dpaa020]
15. Mohammadibakhsh R, Aryankhesal A, Jafari M, Damari B. Family physician model in the health system of selected countries: A comparative study summary. J Educ Health Promot. 2020 Jun;9:1-11. [DOI:10.4103/jehp.jehp_709_19]
16. Arak University of Medical Sciences. Personnel payments [Pamphlet]. Arak: Arak University of Medical Sciences; 2016.
17. Ministry of Health and Medical Education. Instruction pay for the performance of physicians and faculty members working in university-affiliated hospitals / schools of medical sciences and health services of the ministry of health, and medical education [pamphlet]. Tehran: Ministry of Health and Medical Education; 2016.
18. Gharibi F, Dadgar E. Pay-for-performance challenges in family physician program. Malays Fam Physician. 2020;15(2):19-29.
19. Graefe BJ, Markette JF. Physician descriptions of the influence of pay for performance on medical decision-making. Health Policy Open. 2021 Dec;2(100036):1-7. [DOI:10.1016/j.hpopen.2021.100036]
20. Kovacs RJ, Powell-Jackson T, Kristensen SR, Singh N, Borghi J. How are pay-for-performance schemes in healthcare designed in low-and middle-income countries? Typology and systematic literature review. BMC Health Serv Res. 2020 Apr;20(291):1-14. [DOI:10.1186/s12913-020-05075-y]
21. Atkinson P, Delamont S, Cernat A, Sakshaug JW, Williams RA. SAGE research methods foundations. London: SAGE Publications; 2021.
22. Zandiyan H, Ghiasvand H, Nasimi Doost R. Measuring inequality of distribution of health resources: A case study. Payesh. 2012;11(6):799-805.
23. Schneider M. The discovery of the Gini coefficient: Was the Lorenz curve the catalyst? Hist Polit Econ. 2021 Feb;53(1):115-41. [DOI:10.1215/00182702-8816637]
24. Statistical Center of Iran. Social justice indicators [pamphlet]. Tehran: Statistical Center of Iran; 2020.
25. Jahan S. Human development report 2015: Work for human development. New York: United Nations Development Programme; 2015.
26. Homaie Rad E, Bayazidi Y, Delavari S, Rezaei S. Gender gap and inequality in health professionals' income in Iran. Medical Journal of Bakırköy. 2016;12(2):70-5. [DOI:10.5350/BTDMJB201612204]
27. Bayati M, Rashidian A, Akbari Sari A, Emamgholipour S. Target income of Iranian general practitioners: A descriptive helpful study for policies related to rational and equitable payment. Hakim. 2017;20(2):122-30. [In Persian]
28. Bayati M, Rashidian A, Sarikhani Y, Lohivash S. Income inequality among general practitioners in Iran: A decomposition approach. BMC Health Serv Res. 2019 Sep;19(620):1-11. [DOI:10.1186/s12913-019-4473-7]
29. Hidayah N, Dewi A, Jen-ho O, Aini Q. The need to reform the hospital payment system in Indonesia. Malaysian Journal of Public Health Medicine. 2019;19(2):132-40. [DOI:10.37268/mjphm/vol.19/no.2/art.197]
30. Kok L, Boyle S, Lammers M, Tempelman C. Remuneration of medical specialists. Drivers of the differences between six European countries. Health Policy. 2015 Sep;119(9):1188-96. [DOI:10.1016/j.healthpol.2015.04.003]
31. Werner RM, Kolstad JT, Stuart EA, Polsky D. The effect of pay-for-performance in hospitals: Lessons for quality improvement. Health Aff. 2011 Apr;30(4):690-8. [DOI:10.1377/hlthaff.2010.1277]
32. Oxman AD, Fretheim A. Can paying for results help to achieve the millennium development goals? Overview of the effectiveness of results‐based financing. J Evid Based Med. 2009 Aug;2(3): 184-95. [DOI:10.1111/j.1756-5391.2009.01024.x]
33. Gray S, Olyaee Manesh A, Harirchi I, Nedjat S. Designing a framework for "Iranian pay for performance" program for non-medical workforce in hospitals. Health Scope. 2018 Feb;7(S):1-10. [DOI:10.5812/jhealthscope.65472]
34. Kim SM, Jang WM, Ahn HA, Park HJ, Ahn HS. Korean national health insurance value incentive program: Achievements and future directions. J Prev Med Public Health. 2012 May;45(3):148-55. [DOI:10.3961/jpmph.2012.45.3.148]
35. Shaw JD, Gupta N, Delery JE. Pay dispersion and workforce performance: Moderating effects of incentives and interdependence. Strateg Manag J. 2002;23:491-512. [DOI:10.1002/smj.235]
36. Bloom M. The performance effects of pay dispersion on individuals and organizations. Acad Manag J. 1999 Feb;42(1):25-40. [DOI:10.5465/256872]
37. Mathes T, Pieper D, Morche J, Polus S, Jaschinski T, Eikermann M. Pay for performance for hospitals. Cochrane Database Syst Rev. 2019 Jul; (7):1-107. [DOI:10.1002/14651858.CD011156.pub2]

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