Table 6.

Overview of categories and subcategories of inhibiting factors of participation in the cardiology programme.

Category	Sub-category	Number of statements on the category (Number of physicians with statements)
Structural inhibiting factors		25 (8)
	Implementation efforts (see section “Structural inhibiting factors”)	14 (7)
	New practice ID-15: “I entered the practice as recently as 2014, I entered the structures, the structures did not allow for it [the cardiology programme]. […]”	4 (4)
	Computer issues ID-14: “Furthermore I need a more powerful computer if I’m unlucky because the current one will become too slow then for the VPN, so I don’t personally see this financial benefit for me being that exorbitant I have to say.”	4 (3)
	Local lack of participating patients ID-16: “[…] economically it did not pay off, there were too few patients participating. […]”	2 (1)
	High percentage of private patients in practice ID-17: “So here in the practice there is, you have to say, a high percentage of private patients – right, that for sure is a reason why you say: ‘Well, okay, it [the cardiology programme] is not that vital’.”	1 (1)
External inhibiting factors (category had been asked for explicitly)		15 (11)
	Colleagues’ attitudes towards the cardiology programme (see section “External inhibiting factors”)	12 (11)
	Negative experiences of colleagues ID-17: “Yes, indeed I adopted a practice. […] And with it I kind of adopted the status too, as it was conveyed to me that it [the cardiology programme] wasn’t necessarily favourable.”	3 (2)
Other inhibiting factors		15 (5)
	The programme stimulates an intentionally wrong coding of cases (see section “Other inhibiting factors”)	3 (2)
	Individual principles (see section “Other inhibiting factors”)	2 (2)
	No benefits for participating patients ID-20: “Well, the physicians receive more money, but I think that…well, I imagine that independent of the programme I don’t take worse care of non-participants than of those in the programme.”	2 (1)
	No examinations at the hospital allowed for participating physicians ID-19: “[…] for a long time, the main reason was that we, our practice, also conducted examinations with an intracardiac catheter but not in a practice but inside the hospital. And…or in the hospital here in [PLACE] and then it wasn’t possible any longer with it [the cardiology programme] back then, merely for practical reasons because it was a requirement of the programme that you, well ‘ambulatory instead of inpatient’, right? […]”	2 (1)
	No benefits of the programme besides remuneration ID-20: “I think it…physicians receive more money, that’s right, but I…I can’t…I don’t see any improvement.”	1 (1)
	Appointments within the programme are not prioritised by urgency ID-20: “And they come here urgently and say: ‘We need to wait for half a year’, I can’t understand it. […] this, I think, is sometimes related to the medical specialist’s programme. […] they are not insured by [health insurers offering the programme]. So, they automatically fall through the cracks which I think is highly problematic.”	1 (1)
	Programme worsens physician-patient-relationship ID-18: “I think that health insurers and physicians are two separate institutions who need to fulfil their own tasks each and I think that the physician is, through these health care structures like the medical specialist’s programme, influenced sooner or later regarding autonomy so that the physician-patient-relationship is worsened.”	1 (1)
Autonomy-related inhibiting factors		13 (4)
	The programme jeopardises professional autonomy (see section “Autonomy-related inhibiting factors”)	6 (2)
	The programme restricts prescriptions (see section “Autonomy-related inhibiting factors”)	2 (2)
	The patient is bereft of their freedom of choice in physicians/therapies (see section “Autonomy-related inhibiting factors”)	2 (2)
	Supervision through health insurers ID-18: “[…] you should rather allow physicians to further prescribe what they deem adequate, if they suitably continue their education, yeah. And not perform any benchmark tests or various checks by the [HEALTH INSURER] because one admits too many patients to the hospital or too few patients. Or if one’s prescribing too much drugs for heart failure or too expensive ones or too cheap ones. […]”	2 (1)
	The programme contains lots of requirements ID-14: “[…] what bothered me as well, I have to say, is that this programme dictates to you a lot. […]”	1(1)
Economic inhibiting factors		3 (3)
	Disproportion of costs and earnings ID-16: “Yes, so I had to pay higher software license fees, I had to pay rent for the connecting device and what…and my assistant or we had to make a second accounting and in total everything created more work than it was good for financially.”	2 (2)
	Financial barriers Researcher: “[…] simply the investments you have to make…” ID-21: “Correct.”	1 (1)
Professional political inhibiting factors		2 (1)
	Disempowerment of the Associations of Statutory Health Insurance Physicians (see section “Professional politicial inhibiting factors”)	2 (1)