Entre dynamique d'amélioration de la qualité des soins et conformisme administratif: comportements des établissements de santé français face au paiement à la performance (P4P)

The pay-for-performance (P4P) model continues to develop in the health systems of the industrialised countries, despite the limited evidence of its effectiveness. The goal of this study is to understand the behaviours of hospitals in this new payment model, based on the pilot project conducted in France. To do this, we combined a questionnaire-based quantitative approach with participating institutions and a qualitative analysis of nine facilities to better identify the processes at work. The study shows that corrective actions have been taken in some institutions but the impacts of the program on the organization are, in fact, quite limited since they occur more in the margin. It seems that the behaviours essentially reflect a will of conformation to the authority from the part of the organizations, without major organizational changes. However, it will be interesting to see how the different perceptions will structure the behaviours in the long-term.