Patients' views on pay for performance in France: a qualitative study in primary care

Abstract

Background: Pay for performance was implemented in 2009 in France. The system was optional at first and then became widespread. Since 2012, it has been standard for most GPs. Several studies have attempted to investigate its efficiency and the GP's opinion of the system, but few studies have yet to examine the patient's view.

Aim: To gain an understanding of the views of French family practice patients about pay for performance.

Design and setting: Forty patients were interviewed between March and July 2013 in the Île-de-France region, of France.

Method: A qualitative study using semi-structured individual interviews, in primary care.

Results: Most of the patients did not know what pay for performance was and stated that they had not noticed any change in care since the system began. Some patients noted the possible benefits in the quality of care, such as an improvement in follow-up and prevention, better information provided by the GP, and a decrease in the volume of prescriptions and therefore health costs. Other patients were concerned about potential downsides, such as an overprescription of unnecessary medical treatments, an increase in health costs, patient selection, and standardised consultations that do not necessarily take into account the patient's individual concerns.

Conclusion: Since implementation of pay for performance, patients had not noticed any modification in their medical care. They could understand the need for change in the remuneration policy and expressed their agreement about performance-based remuneration if, and only if, it is not the cause of depersonalised health care.

Keywords: family medicine; patients’ satisfaction; primary health care; quality of care; reimbursement incentives.