The importance attached by the countries to the health is measured with the resource allocated to healthcare services in proportion to the national income. On the other hand, many countries have scarce resources. The developing countries strive for having the grasp of a rapid change process appropriate to healthcare services and in parallel to the general tendencies in the world. One of the most determinant elements of this process is a search for maximum efficiency in the use of the resources. Performance based implementations are among the products of a search for efficiency.
The increase in the opinions holding that the efficiency has decreased in the provision of the healthcare service and the use of healthcare resources, new ideas had been brought forward for improving the quality and safety of healthcare services and the hospitals throughout the world had undertaken studies for enhancing their administrative autonomy and financial responsibilities.
As a result of the developments in the healthcare sector, it was seen that the payment methods used for waging the healthcare personnel such as payment per service, payment per capita or fixed payment could not accomplish the desired success in healthcare services, and performance based payment methods that increase the efficiency, brings about a higher quality service and achieves good results began to be foregrounded.
In the healthcare sector of our country, since the early 1980s, different incentive mechanisms had been implemented. The incentive mechanisms followed a rather different route in the last decade. Performance based supplementary payment, which had been put into force since 2003 as an incentive component, is a first time implemented procedure in the public sector in Turkey.
Performance based supplementary payment is a payment made to the healthcare personnel in addition to their regular salaries. The main salary is paid from the budget item of the Ministry of Health (under the item of healthcare personnel salaries.) Performance based supplementary payments, on the other hand, are made from the earnings obtained from the services rendered to the citizens from Social Security Institution and from other institutions.
Performance based supplementary payment, which had been developed as an implementation peculiar to our country, had been initiated as pilot applications in 10 provinces in 2003 for the purpose of improving the healthcare services by measuring the individual performance, enhancing the success level and encouraging the provision of a quality and efficient service.
Following the pilot applications, considering the outputs and feedback from 10 provinces, the implementation had been developed and had been put into operation in all healthcare institutions affiliated to the Ministry of Health as of the beginning of 2004.
The main objective of performance based supplementary payment is to encourage the work motivation and productivity of the public sector healthcare personnel. When the Health Transformation Program had begun, it was understood that the problem of the inadequacy of the human forces in public sector could impede the accomplishment of the objectives of Health Transformation Program. Since the program had started, until today, the ration of the healthcare personnel per population is lower than other middle-income countries and OECD countries. Most of the physicians working in public sector used to prefer to work on a part-time basis. As of 2002, while the ratio of the fulltime employed specialist physicians working in state hospitals were 11%, this had increased to 72% in the first half of 2008. The overcrowded hospitals, and the long waiting periods before being examined used to cause decreases in the patient satisfaction from the healthcare services. The performance based supplementary payment implementation had been considered as a solution within the framework outlined above.
The detailed information on the successful implementation of performance based supplementary payment can be found in the book Performance Management in Healthcare