In line with one of the components of HTP, namely “knowledge and skills- equipped and highly motivated health service personnel," a PBSP system was introduced in MoH hospitals in 2004 (OECD-WB 2008, 49). Under the PBSP system, health personnel receive a payment each month in addition to their regular salaries. The bonus payment for a health worker is determined through a combination of both individual and institutional performance criteria, including indicators of service quality. The base salary is paid from the MoH line item budget under health personnel salaries. The PBSPs are paid from the revolving funds that are financed from the reimbursements hospitals receive from the GHI system and out-of-pocket expenditures paid by patients (Vujicic, Sparkes, and Mollahaliloglu 2009).

The aim of the PBSP system is to motivate employees by giving them quite large bonuses. The largest possible monthly bonus is 800 percent of the regular salary of a clinical chief. The PBSP system also aims to increase the productivity of public sector health personnel. According to MoH, at the time of the

PBSP system launch, the ratio of health personnel to population was lower than in other middle-income and OECD countries, the majority of public doctors worked part-iime, and doctors preferred to work in the private sector. In as much as PBSP could encourage doctors to work more hours in the public sector, there was the potential to shorten the long queues in public hospitals, shorten long waiting times to see a doctor, and improve low patient and provider satisfaction with the health system. In addition, it was hoped that PBSP would improve the performance of the MoH hospitals, with an emphasis on patient satisfaction (MoH 2008, 45; OECD-WB 2008, 49).

The PBSP system in Turkey can be viewed as having three phases: (a) before 2004, (b) the PBSP system in 2004, and (c) the Quality Improvement and Performance Evaluation System from 2005 onward.

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