Document Type : Original Article



CONTEXT: Payment mechanisms are one of the effective tools for achieving optimal results in
health system. Pay for performance (P4P) is one of the best programs to enhance the quality of
health services through financial incentives. Considering of implementing family physician program
in Iran and the P4P system, it is essential to address the challenges of implementing P4P system
in the family physician program.
AIMS: This study aimed to investigate the challenges of implementation of P4P system in family
physician program.
SETTINGS AND DESIGN: The qualitative study was carried out at areas covered by Iran University
of Medical Sciences in Tehran, Iran.
MATERIALS AND METHODS: The semi‑structured interview was conducted on 32 key informants
in 2019. The sampling method was determined based on purposeful sampling. The topic guide
of interviews was experiences in implementing of family physician program and challenges of
implementing P4P system. Participants had least 5‑year experience in the family physician program.
STATISTICAL ANALYSIS USED: A framework analysis was used to analyze the data using the
software MAXQDA 10.
RESULTS: The current study identified 7 themes, 14 subthemes, and 46 items related to the
challenges to successful implementation of P4P systems in the family physician program including
family physicians’ workload, family physician training, promoting family physician program, paying
to the family physician team, assessment and monitoring systems, information management, and
the level of authority of family physicians.
CONCLUSION: The study results demonstrated notable challenges for successful implementation
of P4P system which can helpful to managers and policymakers.


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