Case Study Methodology for Studying Financial Incentives in Context

This paper describes a method for the case study of financial incentives in health care systems. This approach is for applying a conceptual framework that describes funding changes -- and their transformation into “financial incentives” that change behaviour -- as a communication process rather than as a behavioural conditioning exercise. The “cases” in question were changes in health system funding. The two initial research questions were: given a funding change, 1) what policy making process produced the payment policy, and what were its features, and, 2) how did affected organizations interpret this financial “signal” and respond in ways that might give insight into its “incentive” properties? Empirical study was divided into several phases, including I) the description of the funding policy; II) investigation into the origin of the policy; III) identification of affected stakeholders and investigation of their interpretations of and responses to the funding change. Data sources primarily consisted of documents and interviews. Analysis focused on: 1) describing the case, its evolution, and its policy interest; 2) describing any concrete consequences of the funding change; 3) generating analytic categories such as stakeholder coalitions and themes in their interpretation of the policy messages carried by the funding change. We used several methods of triangulation to verify both the “facts” and the conclusions drawn from them, including data source triangulation, investigator triangulation, theory triangulation, methodological triangulation, and member-checking.