Designing a performance-based payment model for physicians at outpatient clinics contracted with Iran health insurance: a case study from Iran.

Background: Providing quality healthcare services relies on capable physicians with high performance levels. A performance-based payment system can enhance physician productivity, clinical service quality, and patient satisfaction. This study aimed to design a performance-based payment model for physicians in outpatient clinics contracted with the Iran Health Insurance Organization, tailored to its specific context and structure.

Methods: The study employed a mixed-methods approach, combining quantitative and qualitative data collection and analysis. Through a literature review and expert interviews, 47 performance indicators and 18 selection criteria were identified. These indicators were reviewed in expert panels, and 49 questionnaires were used to prioritize them based on health insurance structures. The final indicators were categorized into current, transitional, and desired statuses, aligned with organizational infrastructures.

Results: The study identified 24 key indicators, including 9 for general physicians and 13 for specialized physicians. These indicators covered aspects such as the average number of prescribed medications, electronic prescription usage, per capita diagnostic procedures, timely physician presence, patient complaints, work history, guideline adherence, electronic record completion, patient satisfaction, training participation, and test prescription rates. Each indicator was detailed with a title, formula, standard, data collection method, and source.

Conclusions: The proposed performance-based payment model, utilizing the selected indicators, can guide physicians toward achieving organizational goals such as cost reduction, process efficiency, and improved patient satisfaction. By clarifying expe tations and assessing various performance dimensions, the model provides a framework for enhancing physician performance and aligning it with the objectives of the Health Insurance Organization. Policymakers can use this model to drive systemic improvements in healthcare delivery.