Table 4.

Overview of categories and subcategories of incentives to participate in the cardiology programme.

Category	Sub-category	Number of statements on the category (Number of physicians with statements)
External incentives (category had been asked for explicitly)		29 (21)
	Colleagues’ attitudes towards the cardiology programme (see section “Motivation through peers”)	27 (21)
	Advertising/peer pressure (from other physicians) ID-2: “[…] And as a physicians’ organization…and the [ORGANIZATION] was very strong in this area, they…very early they raised solidarity among physicians to some degree.”	2 (2)
Economic incentives		27 (16)
	Aspects of remuneration (see section “Economic incentives”)	20 (16)
	No cap on patient numbers in the programme ID-10: “[…] And thirdly we’re able to see more patients overall [in the cardiology programme] because in the system of the Association of Statutory Health Insurance Physicians we are budgeted regarding patient numbers.”	5 (4)
	Aspects of accounting ID-4: “Yes, of course, there was dissatisfaction with accounting in the system of the Association of Statutory Health Insurance Physicians, regarding caps on numbers of cases. So, a lot of things that made you dissatisfied beforehand seemed to be better from the outset and this proved to be true for me, yes.”	2 (2)
Incentives related to reputation (category had been asked for explicitly)	(see section “Reputational benefits”)	20 (20)
Incentives related to health care		19 (11)
	Better/more services for patients through the programme (see section “Expected improvements related to health care”)	16 (9)
	More medical guideline-oriented care than regular health care ID-8: “Yeah, sure, you might adhere more strictly to guideline-oriented, rational medicine now, yes.”	2 (2)
	Better cooperation with general practitioners than in regular health care ID-9: “[…] So this means, background, maybe better cooperation between general practitioner, medical specialist, a more distinct task sharing.”	1 (1)
Professional political incentives (category had been asked for explicitly)		10 (6)
	ID-2: “[…] And secondly I’ve been a long-time member of [ORGANIZATION] for political considerations. So, the whole thing was a logical consequence.”
	ID-13: “[…] so I remember that beforehand these scenarios of leaving the system of the Association of Statutory Health Insurance Physicians had been discussed […]. […] And so that these, let’s call it politicisations of this dispute, were already advanced. And so one of these reasons for participating in this alternative system [the cardiology programme] was definitely also a political one. […]”
Structural incentives		8 (5)
	Binding of patients ID-5: “[…] I did not want to give off patients to other colleagues, say if someone participates in the medical specialist’s programme, especially after orthopaedics and gastroenterology started, it was important to me that I could still take care of the patients I already had.”	2 (2)
	Alternative to/advancement compared to the system of the Association of Statutory Health Insurance Physicians ID-5: “Being a health economist I know that something has to change in the system of statutory health insurance physicians or in the overall health care system, that we need a paradigm shift within the health care system, that we can’t manage this through a total upheaval but need sub-steps and I classify the system of selective contracts as a small or maybe even a big step in this change in system. […]”	2 (2)
	High percentage of patients insured through AOK/Bosch BKK ID-8: “[…] sure, in the beginning only AOK was involved. […] Sure, my clientele here contains a relatively high percentage of AOK-patients, right? Sure, if you only have two percent of AOK-patients you need to think about what you’re going to do. […]”	1 (1)
	Referral within the programme is only possible between participating physicians ID-11: “[…] The situation is that only medical specialists who participate may be chosen or referred to. This was the original idea. That’s why it made sense to participate in it of course. So that general practitioners are able to refer to a medical specialist who also participates in the programme.”	1 (1)
	Taking over an already participating practice ID-12: “My predecessor was one of the first participants in the programme. I joined later and started to participate in the programme as well. So I continued with an existing system. […]”	1 (1)
	Hope for a successful implementation of software ID-8: “[…] partially, it was no insignificant effort software-wise. I had, well, since I’m practice-based I had relatively great faith in my software-provider to wangle it properly. Other colleagues had a lot more difficulties I think.”	1 (1)
Incentives related to personal background/involvement in the underlying contract		4 (3)
	ID-4: “So, of course I know [PERSON] pretty well, who was involved in negotiating the contract […]. So I witnessed a lot of things there and that influenced me of course. […] So for us it was clear from the get-go because we were very close to the origination [of the cardiology programme] and I noticed how they negotiated and so on. Just because I knew the participants in the negotiations [personally], so it was clear for us to participate from the get-go. […]”
	ID-9: “I am a member of [ORGANIZATION] and tracked the development of the contracts and also got to know the general framework during the development phase. This clearly made me decide for this kind of contract.” ID-22: “The main reason was that I’m a board member of [ORGANIZATION] and therefore was already involved in the development of the contract. […] And therefore it was clear for me to participate in the programme myself.”
	ID-22: “The main reason was that I’m a board member of [ORGANIZATION] and therefore was already involved in the development of the contract. […] And therefore it was clear for me to participate in the programme myself.”