The use of pay for performance (P4P) and public reporting of performance (PR) in health care is increasing rapidly worldwide. The rationale for P4P and PR comes from experience in other industries and from theories about incentive use from psychology, economics, and organizational behavior. This paper reviews the major themes from this prior research and considers how they might be applied to health care. The resulting conceptual model addresses the dual nature (combining direct financial and reputational incentives) of the initiatives many policymakers are pursuing. It also includes explicit recognition of the key contextual factors (at the levels of the markets and the provider organization) and provider and patient characteristics that can enhance or mitigate response to incentives. Evaluation of the existing literature (through June 2005) about incentive use in health care in light of the conceptual model highlights important weaknesses in the way that trials have been reported to date and suggests future research topics.
Bibliographical noteFunding Information:
This work was supported by the Agency for Healthcare Research and Quality, the Commonwealth Fund, and the Robert Wood Johnson Foundation Investigator Award Program. The views expressed are those of the authors and do not necessarily reflect the views of their employers or the funding bodies that supported the research.
Copyright 2008 Elsevier B.V., All rights reserved.
- Health care
- Pay for performance
- Public reporting
- Quality improvement