14

Early 2009, the French public health insurance fund launched a so-called “performance-based remuneration” programme for general practitioners : the “Contrat d’amélioration des pratiques individuelles” (CAPI – a contract to improve individual practices). It offers doctors who sign in to raise their remuneration in exchange for improving the quality of their practice, measured by a battery of indicators. The article seeks to highlight the factors that prompt a doctor to join the programme or not, drawing on Focus group-type collective interviews both with practitioners who are CAPI members and others who are not. Based on a grid designed by a multi-disciplinary team, the study shows that their type of positioning towards the national health insurance fund is the primary factor liable to predict their choice. A second factor, however, plays its part : the a priori assessment by doctors of the CAPI indicators’ capacity to provide an adequate image of general medicine practices. The authors discuss the limits of these results and show how non-monetary incentives could complement CAPI schemes and help non-members to improve their practices.