Table 2.

Current Dutch payment models based on the typology of Quinn (2015) [35] and the HCP-LAN (2017) [36] and their (financial) incentives.

Payment Model	Providers	Incentivises	Literature
Combination of contract capitation payment and fee for service	General practitioner	Positive Fewer referrals Adequate provision of care (no under- or overtreatment) Preventive care Negative Collaboration not explicitly addressed	[20,47,48,49]
Fee for service (FFS)	Physiotherapist, exercise therapist, speech therapist, dietician, and district nursing	Positive High productivity Transparency of the delivered care Negative Overprovision Unnecessary readmissions and diagnostics Quality of care not explicitly addressed Fragmentation of care Preventive care not stimulated	[50,51,52,53]
Per time period	Salary paid health care providers	Positive Cost-conscious behaviour Negative Undertreatment Selection of patients Low productivity which could result in longer waiting lists Quality of care not explicitly addressed Unnecessary referrals	[54,55,56]
Per episode (chronic care)	The SDMPs for chronic diseases in primary care	Positive Integrated care (coordination and continuity) Cost-conscious behaviour High quality of care Efficient care Negative Risk selection ‘Over-bundling’ * Double billing Unnecessary referrals Undertreatment within the bundle	[14,50,57,58,59,60]
Per episode (1. DTCs in specialist care, 2. Per patient profile and time, and 3. Per treatment activity and time)	Medical specialists General basic psychologists Specialist psychologists	Positive Less fragmentation of care Efficiency Negative Strategic declaration behaviour Overprovision Upcoding	[61,62,63]
Contract capitation in combination with a patient co-payment (€19 per month)	Social care	Positive Wide access because of the low co-payment Flexibility to tailor help to personal circumstances Negative Underuse because of accumulating co-payments	[64,65]
Pay for performance	Alternative payment model	Positive Quality of care explicitly addressed Transparency of care Positive spill-over effects ** Negative Negative spill-over effects ** Risk selection Gaming behaviour No incentive if threshold is met Providers held accountable for outcomes they may not be able to influence	[37,40,41,66,67,68,69,70]
Shared savings model	Alternative payment model	Positive Cost-conscious behaviour Integrated care (coordination and continuity) Preventive care Quality of care (implicitly and explicitly) Negative Undertreatment To drive the expenditures of the benchmark	[13,14,15,42,43,71,72,73,74]
(Sub)population—based bundled payment	Alternative payment model	Positive Integrated care (coordination and continuity) Quality of care Cost-conscious behaviour Preventive care Negative High risk for the contracting entity Reduction of necessary care in the bundle Less freedom of choice Risk selection	[16,17,18,45]

Note: DMPs = disease management programmes, DTCs = disease-treatment combinations. * Over-bundling refers to the incentive to broaden the diagnoses, as to increase the target population for which a provider receives a bundled payment (e.g., including pre-diabetes patients at risk of developing diabetes in the bundled payment of diabetes patients). ** Positive spill-over effects occur when non-measured outcomes improve as well, as a consequence of the extra attention for the measured outcomes. Negative spill-over effects occur when a focus on measured outcomes leads to non-measured outcomes being neglected and deteriorating.