Pay for Perfomance and Other Impotent Incentives

One of the central approaches for quality improvement these days seems to be pay-for-performance (P4P), but its effectiveness doesn't seem to be there. “Overall, P4P contracts were not associated with greater improvement in quality compared to a rising secular trend." Worse, there are unintended consequences – misaligned incentives, for instance, that lead to unnecessary or irrelevant testing or procedures.

"Forget P4P" – Originally published on Sep 09, 2008

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In "Effects of Pay for

Submitted by Administrator on Wed, 2009-07-22 18:27.

In "Effects of Pay for Performance on the Quality of Primary Care in England" NEJM July 23, 2009;361(4):368-378 by S.M. Campbell and Others [Free full text], the conclusion is dishartening:
 
 
Conclusions "Against a background of increases in the quality of care before the pay-for-performance scheme was introduced [and the fact that practices were changing--midlevel practitioners, larger group size, etc.], the scheme accelerated improvements in quality for two of three chronic conditions in the short term. However, once targets were reached, the improvement in the quality of care for patients with these conditions slowed, and the quality of care declined for two conditions that had not been linked to incentives. Continuity of care was reduced after the introduction of the scheme."

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