Rethinking Academic Hospital Remuneration Through Value Chain-Based Hybrid Gainsharing: A Scoping Review
DOI:
https://doi.org/10.59141/-.v8i2.572Keywords:
Academic Hospital, Remuneration, Hybrid Gainsharing, Value Chain, Value-Based PaymentAbstract
Academic hospitals integrate clinical care, education, research, and innovation; however, conventional remuneration systems often prioritize clinical productivity while undervaluing academic contributions. This study aimed to map the existing evidence on remuneration models and propose an integrated framework aligning professional contributions with institutional value creation. A scoping review was conducted using PubMed to identify English-language publications from 2010 through August 2026, supplemented by reference list screening and targeted source verification. Records were screened using Rayyan, relevant data were extracted into a structured matrix, and findings were synthesized thematically in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Of the 142 records identified, 29 studies published between 2008 and 2026 were included. Four thematic domains emerged: academic remuneration, hybrid gainsharing, value-based payment, and organizational performance. Existing remuneration models addressed educational contributions, efficiency gains, quality accountability, and institutional sustainability separately, without comprehensively integrating these dimensions across the academic hospital value chain. The proposed framework incorporated fixed remuneration, individual clinical and academic performance incentives, team-based gainsharing, and organization-wide gainsharing, supported by safeguards for healthcare quality, patient safety, equity, academic responsibilities, financial affordability, and institutional sustainability. These findings suggested that multidimensional incentive structures could strengthen alignment between professional performance and institutional missions while reducing excessive dependence on clinical productivity metrics. The proposed framework provided a conceptual foundation for remuneration reform in Indonesian academic hospitals; however, stakeholder consultation, empirical validation, and financial simulations were necessary before its practical implementation.
Downloads
References
Al-Aqeel, S. A., AlAujan, S. S., Alowaisi, M., & Almousa, R. (2026). Design of value-based payments for pharmacist services: A scoping review. Research in Social and Administrative Pharmacy, 22(5), 636–645. https://doi.org/10.1016/j.sapharm.2026.02.012
Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. https://doi.org/10.1080/1364557032000119616
Arnold, D. R. (2017). Countervailing incentives in value-based payment. Healthcare, 5(3), 125–128. https://doi.org/10.1016/j.hjdsi.2016.04.009
Arnold, F. W., Wiemken, T. L., Peyrani, P., Ramirez, J. A., & Brock, G. N. (2013). Mortality differences among hospitalized patients with community-acquired pneumonia in three world regions: Results from the Community-Acquired Pneumonia Organization (CAPO) International Cohort Study. Respiratory Medicine, 107(7), 1101–1111.
Beck Dallaghan, G. L., Wright, S. T., Plant, J., Butani, L., & Morgenstern, B. Z. (2023). Educational relative value units as a measure of academic productivity: A systematic review. Cureus, 15(4), e36995. https://doi.org/10.7759/cureus.36995
Butani, L., & Plant, J. (2021). Establishing an educational value unit to promote teaching in an academic unit. Education for Health, 34(3), 109–112. https://doi.org/10.4103/efh.EfH_332_18
Cattel, D., & Eijkenaar, F. (2020). Value-based provider payment initiatives combining global payments with explicit quality incentives: A systematic review. Medical Care Research and Review, 77(6), 511–537. https://doi.org/10.1177/1077558719856775
Chee, T. T., Ryan, A. M., Wasfy, J. H., & Borden, W. B. (2016). Current state of value-based purchasing programs. Circulation, 133(22), 2197–2205. https://doi.org/10.1161/CIRCULATIONAHA.115.010268
Chen, D., & Guo, X. (2023). Digital finance and sustainability: Impacts, challenges, and policy priorities. Sustainability, 15(20), 14830.
D’Angelo, E. J., & Gallagher, K. (2016). Capturing psychologists’ work in academic health settings: The role of the Educational Value Unit. Journal of Clinical Psychology in Medical Settings, 23(1), 21–32. https://doi.org/10.1007/s10880-016-9453-z
Evans, D. B., & Mayer, J. B. (2024). Surgeon compensation in academic medicine. Surgery, 175(6), 1611–1618. https://doi.org/10.1016/j.surg.2024.01.022
Gottlieb, M., Regan, L., Jordan, J., Westrick, J., & Bailitz, J. (2023). Education Value Units in medical education: A scoping review. Academic Medicine, 98(6), 743–750. https://doi.org/10.1097/ACM.0000000000005130
Gourevitch, M. N. (2014). Population health and the academic medical center: The time is right. Academic Medicine, 89(4), 544–549. https://doi.org/10.1097/ACM.0000000000000171
House, J., Santen, S. A., Carney, M., Nypaver, M., Fischer, J. P., & Hopson, L. R. (2015). Implementation of an Education Value Unit system to recognize faculty contributions. Western Journal of Emergency Medicine, 16(6), 952–956. https://doi.org/10.5811/westjem.2015.8.26136
Hudson, M. E. (2015). Preparing for budget-based payment methodologies: Global payment and episode-based payment. Current Opinion in Anaesthesiology, 28(5), 610–614. https://doi.org/10.1097/ACO.0000000000000239
Husain, A., Chen, D. A., & Lelli, G. J. (2023). A review on the use of the Educational Value Unit among teaching hospitals. Healthcare, 11(1), 136. https://doi.org/10.3390/healthcare11010136
Indonesia. (2018). Presidential Regulation of the Republic of Indonesia Number 82 of 2018 concerning Health Insurance. https://peraturan.bpk.go.id/Details/94711/perpres-no-82-tahun-2018
Indonesia. (2024). Government Regulation of the Republic of Indonesia Number 28 of 2024 concerning Implementing Regulations of Law Number 17 of 2023 concerning Health. https://peraturan.bpk.go.id/Details/294077/pp-no-28-tahun-2024
Jenkins, D., Short, M. N., & Ho, V. (2024). The determinants of nonprofit hospital CEO compensation. PLOS ONE, 19(7), e0306571. https://doi.org/10.1371/journal.pone.0306571
Joynt Maddox, K. E., Sen, A. P., Samson, L. W., Zuckerman, R. B., DeLew, N., & Epstein, A. M. (2017). Elements of program design in Medicare’s value-based and alternative payment models: A narrative review. Journal of General Internal Medicine, 32(11), 1249–1254. https://doi.org/10.1007/s11606-017-4125-8
Ketcham, J. D., & Furukawa, M. F. (2008). Hospital-physician gainsharing in cardiology. Health Affairs, 27(3), 803–812. https://doi.org/10.1377/hlthaff.27.3.803
Lakshminrusimha, S., Reed, A. M., Cheng, T. L., Cunningham, J. M., & Devaskar, S. U. (2023). An approach to compensation plans for physician faculty in academic pediatric departments. The Journal of Pediatrics, 262, 113511. https://doi.org/10.1016/j.jpeds.2023.113511
Leão, D. L. L., Cremers, H. P., van Veghel, D., Pavlova, M., & Groot, W. (2023). The impact of value-based payment models for networks of care and transmural care: A systematic literature review. Applied Health Economics and Health Policy, 21(3), 441–466. https://doi.org/10.1007/s40258-023-00790-z
Levac, D., Colquhoun, H., & O’Brien, K. K. (2010). Scoping studies: Advancing the methodology. Implementation Science, 5, 69. https://doi.org/10.1186/1748-5908-5-69
Malhotra, A., Futela, D., Khunte, M., Wu, X., Payabvash, S., Gandhi, D., Chapiro, J., & Duszak, R. (2025). IR physician compensation at U.S. Medical Schools: Trends and Segments. Journal of Vascular and Interventional Radiology, 36(2), 347-354.e1. https://doi.org/10.1016/j.jvir.2024.10.016
Martin, B., Jones, J., Miller, M., & Johnson-Koenke, R. (2020). Health care professionals’ perceptions of pay-for-performance in practice: A qualitative metasynthesis. Inquiry, 57, 46958020917491. https://doi.org/10.1177/0046958020917491
Mehan, W. A., Schaefer, P. W., & Hirsch, J. A. (2019). Academic performance-based compensation models. Journal of the American College of Radiology, 16(11), 1621–1627. https://doi.org/10.1016/j.jacr.2019.05.021
Porter, M. E. (1985). Competitive advantage: Creating and sustaining superior performance. Free Press.
Regulation of the Minister of Finance Number 172 of 2023 Concerning Application of the Arm’s Length Principle in Transactions Influenced by Special Relationships (2023).
Ryan-Stewart, H., Faulkner, J., & Jobson, S. (2018). The influence of somatotype on anaerobic performance. PLOS ONE, 13(5), e0197761. https://doi.org/10.1371/journal.pone.0197761
Sabeti, H., Kahn, M. J., & Sachs, B. P. (2015). The ‘for-benefit’ academic medical center: A solution for survival. Academic Medicine, 90(5), 599–602. https://doi.org/10.1097/ACM.0000000000000583
Sandhu, A. T., Heidenreich, P. A., Borden, W., Farmer, S. A., Ho, P. M., Hammond, G., Johnson, J. C., Wadhera, R. K., Wasfy, J. H., Biga, C., Takahashi, E., Misra, K. D., & Joynt Maddox, K. E. (2023). Value-based payment for clinicians treating cardiovascular disease: A policy statement from the American Heart Association. Circulation, 148(6), 543–563. https://doi.org/10.1161/CIR.0000000000001143
Slater, B. J., Collings, A. T., Corvin, C., & Kandel, J. J. (2022). Value-based surgery physician compensation model: Review of the literature. Journal of Pediatric Surgery, 57(9), 118–123. https://doi.org/10.1016/j.jpedsurg.2022.01.009
Tricco, A. C., Lillie, E., Zarin, W., O’Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Horsley, T., Weeks, L., Hempel, S., Akl, E. A., Chang, C., McGowan, J., Stewart, L., Hartling, L., Aldcroft, A., Wilson, M. G., Garritty, C., & Straus, S. E. (2018). PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and explanation. Annals of Internal Medicine, 169(7), 467–473. https://doi.org/10.7326/M18-0850
Wicaksono, D., & Bakri, A. (2024). Fraud detection and investigative audit by APIP local governments: Capacity analysis and challenges. Indonesian Journal of Accounting, 14(2), 52.
Yordanov, D., Oxholm, A. S., Prætorius, T., & Kristensen, S. R. (2024). Financial incentives for integrated care: A scoping review and lessons for evidence-based design. Health Policy, 141, 104995. https://doi.org/10.1016/j.healthpol.2024.104995
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Lowly Cania Armys, Wiku Bakti Bawono Adisasmito
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under aCreative Commons Attribution-ShareAlike 4.0 International (CC-BY-SA). that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
