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Insights on the effectiveness of reward schemes from 10‐year longitudinal case studies in 2 Italian regions

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  • Milena Vainieri
  • Daniel Adrian Lungu
  • Sabina Nuti

Abstract

Background Pay for performance (P4P) programs have been widely analysed in literature, and the results regarding their impact on performance are mixed. Moreover, in the real‐life setting, reward schemes are designed combining multiple elements altogether, yet, it is not clear what happens when they are applied using different combinations. Objectives To provide insights on how P4P programs are influenced by 5 key elements: whom, what, how, how many targets, and how much to reward. Methods A qualitative longitudinal analysis of 10 years of P4P reward schemes adopted by the regional administrations of Tuscany and Lombardy (Italy) was conducted. The effects of the P4P features on performance are discussed considering both overall and specific indicators. Results Both regions applied financial reward schemes for General Managers by linking the variable pay to performance. While Tuscany maintained a relatively stable financial incentive design and governance tools, Lombardy changed some elements of the design and introduced, in 2012, a P4P program aimed to reward the providers. The main differences between the 2 cases regard the number of targets (how many), the type (what), and the method applied to set targets (how). Conclusion Considering the overall performance obtained by the 2 regions, it seems that whom, how, and how much to reward are not relevant in the success of P4P programs; instead, the number (how many) and the type (what) of targets set may influence the performance improvement processes driven by financial reward schemes.

Suggested Citation

  • Milena Vainieri & Daniel Adrian Lungu & Sabina Nuti, 2018. "Insights on the effectiveness of reward schemes from 10‐year longitudinal case studies in 2 Italian regions," International Journal of Health Planning and Management, Wiley Blackwell, vol. 33(2), pages 474-484, April.
  • Handle: RePEc:bla:ijhplm:v:33:y:2018:i:2:p:e474-e484
    DOI: 10.1002/hpm.2496
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    Cited by:

    1. Horenberg, Frank & Lungu, Daniel Adrian & Nuti, Sabina, 2020. "Measuring research in the big data era: The evolution of performance measurement systems in the Italian teaching hospitals," Health Policy, Elsevier, vol. 124(12), pages 1387-1394.
    2. Milena Vainieri & Francesca Ferrè & Stefania Manetti, 2021. "An Integrated Framework to Measure the Performance of Inter-Organizational Programme on Health Technology Assessment," Sustainability, MDPI, vol. 13(7), pages 1-17, March.
    3. Verzulli, R.; & Lippi Bruni, M.;, 2022. "The quicker the better: Fostering timely responses in public hospitals," Health, Econometrics and Data Group (HEDG) Working Papers 22/08, HEDG, c/o Department of Economics, University of York.
    4. De Rosis, Sabina & Guidotti, Elisa & Zuccarino, Sara & Venturi, Giulia & Ferré, Francesca, 2020. "Waiting time information in the Italian NHS: A citizen perspective," Health Policy, Elsevier, vol. 124(8), pages 796-804.

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