Performance-based payments and intrinsic motivation among primary healthcare workers in China: a cross-sectional survey
Objective The study aimed to examine whether pay-for-performance (performance-based payment (PBP)) may crowd out intrinsic motivation by analysing the association between the proportions of the PBP component of the total salary and intrinsic motivation levels among primary healthcare workers in Chin...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2025-06-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/6/e090145.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850157040202153984 |
|---|---|
| author | Beibei Yuan Jia Li Haipeng Wang Xianjing Qin |
| author_facet | Beibei Yuan Jia Li Haipeng Wang Xianjing Qin |
| author_sort | Beibei Yuan |
| collection | DOAJ |
| description | Objective The study aimed to examine whether pay-for-performance (performance-based payment (PBP)) may crowd out intrinsic motivation by analysing the association between the proportions of the PBP component of the total salary and intrinsic motivation levels among primary healthcare workers in China.Design A cross-sectional survey. The primary outcome was intrinsic motivation, measured using the intrinsic motivation subscale of the 15-item work motivation scale.Setting and participants The study involved 1927 primary healthcare workers from 31 institutions in Weifang city, Shandong province, China.Interventions The proportion of PBP was the primary intervention variable. Additionally, subanalysis was conducted across different performance dimensions, including whom to incentivise and the domain of performance measured.Results The results revealed a complex relationship between the proportion of the PBP component of the total salary and intrinsic motivation levels among primary healthcare workers. Overall, higher PBP proportions were associated with increased intrinsic motivation scores (β=0.49, p<0.05), particularly when incentives targeted groups rather than individuals (β=1.04, p<0.05) and when both the quantity and quality of care were included in performance measurement (β=0.61, p<0.05). However, when performance was measured solely based on the number of healthcare visits, a significant negative impact on intrinsic motivation was observed (β=−1.19, p<0.05).Conclusion This study underscored the importance of designing PBP schemes to enhance performance without undermining intrinsic motivation among primary healthcare workers. PBP schemes should not only focus on increasing financial incentives but also incorporate incentive methods that acknowledge healthcare workers’ professional contributions and expertise. These findings were crucial for policymakers and healthcare administrators aiming to optimise PBP schemes to enhance performance and ensure the sustainability of the effectiveness of these schemes by preserving intrinsic motivation among China’s primary healthcare workers. |
| format | Article |
| id | doaj-art-4c2505f791bd41f3990a5a2e87181dfe |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-4c2505f791bd41f3990a5a2e87181dfe2025-08-20T02:24:17ZengBMJ Publishing GroupBMJ Open2044-60552025-06-0115610.1136/bmjopen-2024-090145Performance-based payments and intrinsic motivation among primary healthcare workers in China: a cross-sectional surveyBeibei Yuan0Jia Li1Haipeng Wang2Xianjing Qin3China Center for Health Development Study, Peking University, Beijing, ChinaDepartment of Health Policy and Management, School of Public Health, Peking University, Beijing, ChinaSchool of Health Care Management, Shandong University, Jinan, Shandong, ChinaGuangxi Medical University, Nanning, Guangxi, ChinaObjective The study aimed to examine whether pay-for-performance (performance-based payment (PBP)) may crowd out intrinsic motivation by analysing the association between the proportions of the PBP component of the total salary and intrinsic motivation levels among primary healthcare workers in China.Design A cross-sectional survey. The primary outcome was intrinsic motivation, measured using the intrinsic motivation subscale of the 15-item work motivation scale.Setting and participants The study involved 1927 primary healthcare workers from 31 institutions in Weifang city, Shandong province, China.Interventions The proportion of PBP was the primary intervention variable. Additionally, subanalysis was conducted across different performance dimensions, including whom to incentivise and the domain of performance measured.Results The results revealed a complex relationship between the proportion of the PBP component of the total salary and intrinsic motivation levels among primary healthcare workers. Overall, higher PBP proportions were associated with increased intrinsic motivation scores (β=0.49, p<0.05), particularly when incentives targeted groups rather than individuals (β=1.04, p<0.05) and when both the quantity and quality of care were included in performance measurement (β=0.61, p<0.05). However, when performance was measured solely based on the number of healthcare visits, a significant negative impact on intrinsic motivation was observed (β=−1.19, p<0.05).Conclusion This study underscored the importance of designing PBP schemes to enhance performance without undermining intrinsic motivation among primary healthcare workers. PBP schemes should not only focus on increasing financial incentives but also incorporate incentive methods that acknowledge healthcare workers’ professional contributions and expertise. These findings were crucial for policymakers and healthcare administrators aiming to optimise PBP schemes to enhance performance and ensure the sustainability of the effectiveness of these schemes by preserving intrinsic motivation among China’s primary healthcare workers.https://bmjopen.bmj.com/content/15/6/e090145.full |
| spellingShingle | Beibei Yuan Jia Li Haipeng Wang Xianjing Qin Performance-based payments and intrinsic motivation among primary healthcare workers in China: a cross-sectional survey BMJ Open |
| title | Performance-based payments and intrinsic motivation among primary healthcare workers in China: a cross-sectional survey |
| title_full | Performance-based payments and intrinsic motivation among primary healthcare workers in China: a cross-sectional survey |
| title_fullStr | Performance-based payments and intrinsic motivation among primary healthcare workers in China: a cross-sectional survey |
| title_full_unstemmed | Performance-based payments and intrinsic motivation among primary healthcare workers in China: a cross-sectional survey |
| title_short | Performance-based payments and intrinsic motivation among primary healthcare workers in China: a cross-sectional survey |
| title_sort | performance based payments and intrinsic motivation among primary healthcare workers in china a cross sectional survey |
| url | https://bmjopen.bmj.com/content/15/6/e090145.full |
| work_keys_str_mv | AT beibeiyuan performancebasedpaymentsandintrinsicmotivationamongprimaryhealthcareworkersinchinaacrosssectionalsurvey AT jiali performancebasedpaymentsandintrinsicmotivationamongprimaryhealthcareworkersinchinaacrosssectionalsurvey AT haipengwang performancebasedpaymentsandintrinsicmotivationamongprimaryhealthcareworkersinchinaacrosssectionalsurvey AT xianjingqin performancebasedpaymentsandintrinsicmotivationamongprimaryhealthcareworkersinchinaacrosssectionalsurvey |