Barriers and Facilitators to Health-Care Provider Payment Reform – A Scoping Literature Review

Figures & data

Table 1 Search Strategy and Keywords in Databases

Factor	Factor* OR barrier* OR obstacle* OR hurdle* OR imped* OR difficult* OR challenge* OR facilitat* OR promot* OR aid* OR enabl* OR help* OR reason* OR experienc* OR perception* OR determinant* OR influenc* OR constraint* OR issue*
AND
Healthcare provider	“healthcare provider*” OR “care provider*” OR “health provider*” OR “health service provider*” OR “health practice*” OR “healthcare practice*” OR “medical practice*” OR “health institution*” OR “healthcare institution*” OR “health care institution*”
AND
Payment	Pay* OR compensat* OR incentive* OR financ* OR reimburs* OR purchas* OR reward* OR bonus*
AND
Reform	Reform* OR polic* OR chang*

Table 2 General Overview of the Included Publications

Study Reference	Country	Publication Year	Focus of the Publication	Publication Type^a,*	Payment method Modified/ Implemented as Additional /Implemented to Replace	Care Provider	Modified/implemented Payment Method Classification	Reform Classification^b,*	Reform Scope	Reform Stage^c,*
Wojtak and Purbhoo^Citation35	Canada	2015	Barriers and facilitators	Lit rev	Unstated method → bundled methods	Multiple	Prospective, input, output, outcome	Rep	Regional	1, 2
Zhang and Sun^Citation36	China	2021	Provider perspectives	Emp-QN	FFS → DRG	Multiple	Prospective, output	Rep	Pilot	2
Jin et al^Citation37	China	2015	Barriers	Lit rev	FFS → DRG	Hospitals	Prospective, output	Rep	National	2
Zhao et al^Citation38	China	2018	Facilitators	Dis/pp	FF → DRG- case-mix	Hospitals	Prospective, input, output	Rep	National	2
Duran et al^Citation39	Cote d’Ivoire	2020	Barriers and facilitators	Emp-QL	Unstated method + P4P	Primary care	Retrospective, outcome	Add	Pilot	1, 2
Or^Citation40	France	2014	Barriers	Dis/pp	Unstated method → DGR	Multiple	Prospective, output	Rep	National	2
Issahaku et al^Citation41	Ghana	2021	Stakeholder perspectives	Emp-QL	FFS, DRG, capitation → unstated VBP	Multiple	Prospective, output	Rep	National	1
Takyi and Danquah^Citation42	Ghana	2015	Barriers	Dis/pp	FFS, DRG → capitation	Primary care	Prospective, input	Rep	Pilot	2
Andoh-Adjei et al^Citation43	Ghana	2019	Provider perspectives	Emp-QN	FFS, DRG → capitation	Primary care	Prospective, output	Rep	Pilot	2
Nagy and Brandtmüller^Citation44	Hungary	2008	Barriers	Dis/pp	Capitation / adjusted capitation	Multiple	Prospective, input	Mod	National	1
Tan^Citation45	Indonesia	2019	Barriers and facilitators	Emp-mix	Unstated method → capitation	Primary care	Prospective, input	Rep	National	2
Babashahy et al^Citation46	Iran	2017	Analyze barriers	Emp-QL	Unstated method / adjusted capitation + DRG	Multiple	Prospective, output, retrospective, output	Mod, add	National	1
Kwon^Citation47	Korea	2003	Barriers	Dis/pp	FFS → DRG	Multiple	Prospective, input, output, outcome	Rep	Pilot	2, 3
de Vries et al^Citation48	Netherlands	2019	Barriers	Emp-QL	FFS → bundled methods	Multiple	Prospective, output	Rep	National	3
Tummers and Van de Walle^Citation49	Netherlands	2012	Barriers	Emp-QN	Unstated method → DRG	Mental health	Prospective, output	Rep	National	2
Chukwuma et al^Citation50	Romania	2021	Barriers and facilitators.	Tec/pb	Capitation/ adjusted capitation, FFS → bundled methods	Primary care	Prospective, retrospective, input, outputs, outcome	Mod, rep	National	3
Radu and Haraga^Citation51	Romania	2008	Barriers and facilitators	Lit rev	Unstated method → DRG	Hospitals	Prospective, input, output	Rep	National	1, 2, 3
Eriksson et al^Citation52	Sweden	2022	Provider perspectives	Emp-QL	Unstated method → bundled method +P4P	Spine surgery	Prospective, output, outcome	Rep, add	National	1, 2
Aktas^Citation53	Turkey	2022	Provider perspectives	emp-QL	FFS →mixed DRG, global budget	Hospitals	Prospective, output	Rep	National	1, 2, 3
Dredge^Citation54	UK	2008	Barriers and facilitators	Dis/pp	Global budget → DRG	Hospitals	Prospective, input, output, outcome	Rep	National	2
Doran^Citation55	UK	2008	Facilitators and barriers	Dis/pp	Unstated method +P4P	Primary care	Retrospective, outcome	Add	National	1, 2
Conrad et al^Citation14	USA	2014	Barriers and facilitators	Emp-QL	FFS / global + bundled methods	Multiple	Prospective, input, retrospective, outputs	Mod, add	Regional	1, 2
Hussey et al^Citation56	USA	2011	Barriers	Emp-QL	FFS → bundled methods	Multiple	Prospective, output	Rep	Pilot	1, 2, 3
Bokhour et al^Citation57	USA	2006	Stakeholder perspectives	Emp-QL	Unstated method +P4P	Multiple	Retrospective, outcome	Add	National	2
Kamath et al^Citation58	USA	2015	Provider experience	Emp-QN	FFS → bundled methods	Arthroplasty surgery	Prospective, input	Rep	Pilot	1, 2
Whitcomb et al,^Citation59	USA	2015	Barriers and facilitators	Emp-QN	FFS → bundled methods	Joint replacement	Prospective, output, outcomes	Rep	Pilot	2, 3
Blustein et al^Citation60	USA	2011	Barriers	Emp-mix	Unstated method +P4P	Hospitals	Retrospective, input, output, outcome	Add	Regional	1, 2, 3
Miller^Citation61	USA	2012	Barriers	Tec/pb	FFS → bundled methods, Global payment	Multiple	Prospective, input, output	Rep	National	1,2,3
University of Washington^Citation62	USA	2015	Barriers and facilitators.	Tec/pb	FFS → capitation	Multiple	Prospective, input, outcome	Rep	Pilot	1,2,3
Hilary et al^Citation63	USA	2011	Barriers and facilitators.	Tec/pb	FFS → unstated VBP	Multiple	Not stated	Rep	National	1, 2
University of Washington^Citation64	USA	2015	Barriers and facilitators.	Tec/pb	Per visit method → capitation	Primary care	Prospective, output	Rep	Regional	1, 2, 3
Bencic et al^Citation65	USA	2016	Barriers	Tec/pb	FFS → bundled methods	Primary care	Retrospective, output	Rep	Regional	1, 2, 3
Crook et al^Citation66	USA	2021	Barriers and facilitators	Tec/pb	FFS → unstated VBP	Multiple	Not stated	Rep	National	1, 2, 3
Damberg et al^Citation67	USA	2014	Barriers and facilitators	Tec/pb	FFS → P4P, accountable care organizations (ACOs), bundled methods	Multiple	Prospective, retrospective, input, outputs, outcome	Rep	National	1, 2, 3
Dummit^Citation68	USA	2011	Barriers and facilitators	Tec/pb	FFS → bundled methods	Post-acute care	Prospective, output, outcome	Rep	Pilot	2, 3
Voinea-Griffin et al^Citation69	USA	2010	Barriers and facilitators.	Dis/pp	FFS +P4P	Dentistry	Retrospective, outcome	Add	National	1, 2
Bozic et al^Citation70	USA	2007	Barriers	Dis/pp	FFS +P4P	Orthopedics	Retrospective, outcome	Add	National	2
Randazzo and Brown^Citation71	USA	2016	Facilitators	Dis/pp	FFS → bundled methods	Chronic care	Not stated	Rep	Regional	1, 2
Lowder et al^Citation72	USA	2021	Barriers	Dis/pp	FFS → bundled methods, P4P	Multiple	Retrospective, outcome	Rep	National	1
McClellan et al^Citation73	USA	2017	Barriers and facilitators.	Dis/pp	FFS → unstated VBP	Multiple	Not stated	Rep	National	1, 2, 3
Bertko and Effros^Citation74	USA	2011	Barriers and facilitators	Dis/pp	FFS → capitation	Primary care	Retrospective, output	Rep	Pilot	1
Antonova et al^Citation75	USA	2015	Barriers	Dis/pp	FFS, DRGs → bundled methods	Hip fracture care	Prospective, input, output, outcome	Rep	Regional	1.2
Mcclellan^Citation76	USA	2011	Barriers and facilitators	Dis/pp	FFS + P4P, FFS → bundled methods	Multiple	Retrospective, prospective, output, outcome	Add, rep	National	1, 2, 3
Voinea-Griffin et al^Citation77	USA	2010	Barriers and facilitators	Dis/pp	Unstated method +P4P	Dentistry	Retrospective, output, outcome	Add	National	1, 2, 3
Seth Greenwald. et al^Citation78	USA	2016	Facilitators	Dis/pp	FFS → bundled methods	Multiple	Prospective, retrospective, input, output, outcome	Rep	Pilot	1, 2, 3
Hobbs Knutson et al^Citation79	USA	2021	Barriers and facilitators	Dis/pp	FFS → P4P	Behavioral health	Retrospective, output, outcome	Rep	Regional	1, 2
Tanenbaum^Citation80	USA	2009	Facilitators	Lit rev	Unstated method +P4P	Multiple	Retrospective, outcome	Add	National	1, 2
Tsiachristas et al^Citation31	Multi-country	2013	Barriers and facilitators	Emp-mix	FFS + P4P, Salary + pay-for-coordination (PFC), FFS → bundled methods	Integrated chronic care	Prospective, output, retrospective, outcome	Add, rep	National	1, 2
Annear et al^Citation32	Multicounty	2018	Barriers	Lit rev	FFS → DRG	Hospitals	Prospective, input, output	Rep	National	1, 2
Donev^Citation33	Multi-country	2022	Barrier and facilitators.	Dis/pp	Unstated method +P4P	Multiple	Retrospective, output, outcome	Add	National	1, 2, 3
Mathauer and Wittenbecher^Citation34	Multicounty	2013	Barriers	Lit rev	Unstated method → DGRs	Hospitals	Prospective, output	Rep	Pilot, national	1, 2

Notes: ^a,*(emp-QL: empirical study-qualitative, emp-QN: quantitative, or emp-mix: mixed; tec/pb: technical report/policy brief; dis/pp: discussion/policy paper; lit rev: literature review). ^b,*(Mod: Modifying existing payment method; add: Implementing an additional payment method; rep: Replacing existing method with the new one). ^c,*(1. Design; 2. Implementation; 3. Assessment; 4. Not stated).

Figure 1 Presentation of the results following the PRISMA flowchart.

Figure 2 Included study types and publication period on a 5-year scale, starting with the oldest included study published in 2000 and ending with the most recent published studies in 2022. Publications include discussion/policy papers (blue), technical reports/policy briefs (Orange), empirical studies (grey), and literature reviews (yellow).

Figure 3 Study regions from which the included publications originated. Results are shown from left to right, starting with studies covering single countries from America (blue), Europe (green), Asia (yellow), and Africa (dark), and studies covering multiple countries (red).

Table 3 Barriers to Provider Payment Reform

Major Themes	Subthemes	References
Opposition/ reluctance by providers or other stakeholders	Provider reluctance due to dissatisfactory incentives (insufficient provider’s incentives, misaligned incentives, financial instability, etc.).	[31,35,39,41,42,47–49,53,55,57,61,65,79]
	Provider opposition to being held accountable for outcomes they cannot control.	[41,43,48,49,55,57,61,65,70,79]
	Provider reluctance or opposition to reform initiatives seeming to compromise their professional/ clinical autonomy or ethics.	[31,33,37,39,52,53,55,57,69,80]
	Distrust due to previously failed reform attempts or between stakeholders (eg, care providers and government).	[33,41,43,47,48,62]
	Reluctance due to difficulty/the inertia of providers to adjust to the new structure in healthcare.	[14,47,52,61,74]
	Providers reluctance to adopt new payment models because they feel better familiar with the current one.	[14,31,41,61,65]
	Provider opposition to reform initiatives developed without evidence-based facts (clinical, cost, quality, etc.).	[33,43,49,77]
	Provider reluctance due to finding a method as confusing eg, because of the varieties of benchmarks being used for performance programs.	[40,46,52,69]
	Provider opposition to reform initiatives intending to expose client’s privacy / seen as causing negative patient physician relationship.	[14,33,37]
	Provider opposition to reform initiatives they are not involved in arrangement.	[33]
Challenges related to the reform design features	Unavailability of standards/benchmarks (quality, cost, risk-adjustment, etc.).	[34,39,42,56,60,61,63,65–69,72,73,75,77]
	Numerous or ambiguous or unaligned indicators/measures (eg, performance/outcomes).	[14,31,39,45,58,61,69,77]
	Administratively and operationally complex reform initiatives that do not fit the local context (eg, social, cultural or political).	[33,39,46,50,59,63,67]
	Reform initiative requiring substantial administrative tasks/ burden.	[31,39,50,52,59]
	Reform initiative requiring partial/complete redesign of healthcare service delivery.	[14,75,79]
	Differing payment reform design across health plans and providers.	[14,61,65]
	If the design affects too small of a patient population because of its narrow scope.	[55,63,79]
	Other design (technical) challenges: defining a bundle, determining accountability, tariffs, evaluation criteria, outliers, gaming, etc.	[14,31–33,40,51,53,55,56,58,59,67–70,74,75]
Hurdles in implementation structure of the payment system	Confusion due to conflicting/ administrative incongruence between major actors.	[14,33,41,45,47,55,75,76]
	Fragmented implementation structure of the payment system.	[35,39–41,62,69]
	The need to adapt implementation structures to reflect new reform specifics (eg, racial and ethnic disparities, equity, language barriers, etc.).	[35,44,60,63,66,69]
	Lengthy implementing or administrative structures/ bureaucratic process or regulatory delays).	[14,45,59,62,63]
Insufficient resource and capacity	Need for new infrastructure (IT, multi-stakeholder friendly systems, etc.).	[14,32,40,45,63,65–67,79]
	Limited funding/ budget constraints (new costs of data, indicators, staff training, additional payments, etc.).	[32,39,51,63,66,69,70]
	Need for new human resource recruitments (care providers, additional staff, IT personnel, etc.).	[32,34,39,63,65]
	Unequal distribution of human resources (urban Vs rural areas).	[45,68]
	Instability for hospital budgets following reform (eg, due to lack of hospital autonomy in spending).	[32,34,53]
	Having multiple initiatives under way deduce the resources and dilute the effort of any given reform.	[14]
Challenges related to the market structure	Market environments unable to incorporate diverse public and private stakeholders (eg, public and private markets operating under different IT/reporting systems).	[34,40,61,66,73,74,79]
	Market giving participating providers too small number of population (low-volume providers)	[55,63,65,68,79]
	Competing stakeholder priorities at the market.	[14,31,33,47]
	Market split among multi-payers can slow the progress of reform.	[14,63,69,79]
	Attention on the largest payer can limit the valiant efforts of smaller plans with less market share.	[63,66]
Challenges related to legal/regulatory framework	Autonomy mismatch at the central level vs for decentralized entities (eg, lack of fiscal autonomy for decentralized entities).	[33,34,39,45,48]
	Competing health policy and political priorities in legislation.	[33,62,73,76]
	Legal and privacy issues regarding data collection and sharing.	[14,66]
	Requirement for substantial amendments to the national law on health care.	[50]
	Intense political and judicial controversy.	[76]
Knowledge /information gap	Insufficient knowledge / Unfamiliar payment initiative for providers.	[14,33,36,39,43,58,60,73]
	Information asymmetry between stakeholders.	[33,41,43,48]
	IT/Data illiteracy (eg, inability to inputting data into the database; inability to use EMRs, etc.).	[14,34]
Negative publicity / reputation	Worsening reputation of stakeholders (eg, insurers).	[41,48]
	Negative media reportage and publicity (fueling negative provider perceptions to accept reform initiative).	[43,49]

Table 4 Facilitators to Provider Payment Reform

Support & engagement of stakeholders	High participatory efforts to engage diverse stakeholders (insurers, care providers, pharmacies, municipalities, citizen representative organizations, etc.)	[14,32,35,41,43,45,46,51,55,59,61,62,64,66,70,71,73,78]
	Support by larger shareholders	[14,33,38,48,51,53,63,64,73,76,78,80]
	Government interests to create a sense of urgency for a payment reform initiative.	[14,31,41,45,48,51,53,60,63,80]
	High level of commitment by politics/political parties or policymakers’ rationales	[14,31,33,38,41,45,51,63,64,76]
	Clear mechanisms at play related to factors such as leadership, alignment of goals and incentives, shared norms and values as well as the relations between the actors	[33,48,51,54,63,64,71,73,78,80]
	Trust between stakeholders	[14,48,51,62,63,66,71,78,80]
	Reaching reform consensus among stakeholders	[14,41,51,55,73,78,80]
	Communications among stakeholders in coordinating the implementation of the payment system	[14,41,51,52,66,71,73,80]
	Robust support from provider and consumer organizations, major purchasers and health plans.	[41,51,63,64,73,78,80]
	Cohesive alliance structure among local and central actors in the reform implementation.	[14,45,51,66,73,78]
	Transparency in reform negotiations	[40,48,55,60,64,80]
	Involving trusted neutral entities that facilitate the design and implementation of payment reform.	[48,51,60,63,73]
	Willingness of providers to accept the new payment system.	[51,61,64,78,80]
	Supportive community and social networks	[14,51,64,73,80]
	Community involvement	[39,60,66,78]
	Media information about the reform (publicity).	[62,80]
	High doctors’ voices and strikes in a favor of a reform that influenced policymaker/ political views and priorities	[33]
Availability of complementary measures/policies	Favorable market, social, legislative, and regulatory environments aligned with the reform goals.	[14,32,33,41,62,64,80]
	Complementary changes in other healthcare policies/simultaneous in efforts in the healthcare marketplace.	[14,44,51,73,76,80]
	Specific and worthy policies on ethical issues related to professionalism, patient-physician relationship, access to care and patient autonomy.	[32,33,36–38,55]
	Federal or state legislation encouraging payment innovation.	[14,32,64,76,80]
	Presence of regulatory mechanism for robust competition among payers and providers.	[14,64,76]
	Already existing regulatory systems and continuous assessments for reform health initiatives.	[62,63]
	Antitrust policies designed to prevent the exercise of market power.	[61,76]
	Clear policies and their enforcement to counteract anti-competitive behaviors by large providers.	[61]
Having prior experience & “know-how”	Having run pilot project/feasibility study before full adoption/implementation of the real reform initiative.	[14,38,51,53,75,77]
	When the reform builds upon existing infrastructure or lessons learned.	[38,51,54,60,62,63]
	Already existing team and workforce (stability of the team)	[14,31,51,60,63]
	Long history of progressive health reform innovation	[14,51,60,62]
	Relevant experiences of participating organizations	[14,48,51,64]
	Prior experience with legislative, social and regulatory conditions for payment reforms.	[14,41,64]
	Building on the established early partnership	[51,54]
	Benchmarking - Build on and learn from best practices.	[51,54,60]
Sufficient resources	Proper infrastructure	[32,38,48,51,62,71,79]
	Pre-established software/IT systems (eg, electronic health record, data tools (cost, outcome measures)).	[32,34,38,51,71,79]
	Sufficient and trained IT staff	[32,34,51,63,71]
	Data sharing mechanisms and protection (privacy, etc.)	[48,51,75,78]
	Outside investment that enables increased needed resources	[14,51,63,66]
	Supplementary reform funding (grant, sponsorship, loan, etc.)	[14,51,62,64,66]
Good quality leadership & management of change at the providers level	Leader who is instrumental in building and maintaining cohesive relations between the stakeholders.	[14,32,51,62–64,71]
	Flexibility and stable leadership able to analyze market conditions and stakeholder engagement and priorities shift over time.	[14,32,48,51,71]
	Having trusted leadership.	[14,48,63,64,78]
	Timely and consistent feedback management	[32,46,52,63]
	Opportune leadership across reform initiatives to share best practices with one another and explore solutions to challenges.	[14,46,51,78]
	Ability to retain major employees/or timely replacing crucially departing workers (eg, exodus of doctors).	[14,33,71]
	Senior executives’ delegation of decision making to others in their organizations.	[14,31,71]
	Ability to timely handle negative staff attitudes and resistance (conflict resolution).	[32,33,51]
	Timely response to changes (eg, replacing the outdated guidelines/practice)	[51]
	Explicit internal and external supervision	[51]
External pressures toward reform adoption	International interest in healthcare changes	[33]
	Political interests shifted in favor of health reforms due to political cycle	[80]

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