İbrahim Tayfun Şahiner1, Ebru Esen2, Ahmet Deniz Uçar3, Ahmet Serdar Karaca4, Ahmet Çınar Yastı5

1Department of General Surgery, Hitit University Faculty of Medicine, Çorum, Turkey
2 Deparment of General Surgery, Health Sciences University Gülhane Training and Research Hospital, Ankara, Turkey
3Department of General Surgery, Health Sciences University Bozyaka Training and Research Hospital, İzmir, Turkey
4Department of General Surgery, Başkent University Faculty of Medicine, Ankara, Turkey
5Department of General Surgery, Health Science University Ankara City Hospital, Ankara, Turkey


Objective: This study aimed to compare the pay for performance system applied nationally in Turkey and in other countries around the world and to reveal the effects of the system applied in our country on the general surgery.

Material and Methods: Current literature and countries’ programs on the implementation of the pay for performance system were recorded. The results of the Turkish Surgical Association’s performance and Healthcare Implementation Communique (HIC) commission studies were evaluated in light of the literature.

Results: Many countries have implemented performance systems on a limited scale to improve quality, speed up the diagnosis, treatment, and control of certain diseases, and they have generally applied it as a financial promotion by receiving the support of health insurance companies and nongovernmental organizations. It turns out that surgeons in our country feel that they are being wronged because of the injustice in the current system because the property of their works is not appreciated and they cannot get the reward for the work they do. This is also the reason for the reluctance of medical school graduates to choose general surgery.

Conclusion: Authorities should pay attention to the opinions of associations and experts in the related field when creating lists of interventional procedures related to surgery. Equal pay should be given to equal work nationally, and surgeons should be encouraged by incentives to perform detailed, qualified surgeries. There is a possibility that the staff positions opened for general surgery, as well as, all surgical branches will remain empty in the near future.

Keywords: Pay for performance, healthcare implementation practices, P4P

Cite this article as: Şahiner İT, Esen E, Uçar AD, Karaca AS, Yastı AÇ. Pay for performance system in Turkey and the world; a global overview. Turk J Surg 2022; 38 (1): 46-54.


Ethics Committee Approval

For this study, it is not necessary to have the ethical approval as it is a study that does not involve human participants.

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - All of authors; Design - All of authors; Supervision - All of authors; Materials - All of authors;; Data Collection and/or Processing - All of authors; Analysis and/or Interpretation - İ.T.Ş., A.Ç.Y.; Literature Search - İ.T.Ş., A.Ç.Y.; Writing Manuscript - İ.T.Ş., A.Ç.Y.; Critical Reviews - All of authors.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.