Round Table Discussion Pay and Non-Pay Incentives, Performance and Motivation Prepared for WHO’s December 2000 Global Health Workforce Strategy Group, Geneva

This paper provides an overview of evidence of the effects of incentives on the performance and motivation of independent health professionals and health workers. Incentives are viewed in the context of objectives held by paying agencies or employers. The review defines the nature of economic incentives and of non-financial incentives. Particular attention is paid to the need for developing countries to understand the impacts of health reform measures on incentives. A review of current literature found that the response of physicians to economic incentives inherent in payment mechanisms appears to follow directions expected in theory. Incentive structures are becoming more complex, however, as a result of managed care and blended payment mechanisms. There is insufficient evidence of the effects of incentives on motivation and performance of other health workers, due perhaps to a preoccupation of researchers with economic responses. Incentives must be viewed in a broad context in order to understand constraints and success factors that affect their prospects of success. Health human resources should be seen as a complex and interrelated system where incentives aimed at one group of professionals will impact on the entire system.