As industrialized countries around the world encounter rising health care costs with little to show in quality and health outcome improvements, they increasingly are turning to pay-for-performance mechanisms to align provider action with quality, equity, and efficiency goals. The primary objective of most pay-for-performance schemes is to improve quality of care, and the logic of linking financial rewards to quality and performance metrics makes sense. However, despite broad international experience with pay-for-performance, evidence of its impact is limited, frequently conflicting, focuses largely on improvements in the provision and structure of care rather than health outcomes, and tends to generate more questions than it does answers.
Division of Health Promotion & Behavioral Sciences, University of Texas Health Science Center School of Public Health, Austin, Texas.
Correspondence: Kimberly J. Wilson, MPIA, Division of Health Promotion & Behavioral Sciences, University of Texas Health Science Center School of Public Health, Austin Regional Campus, 1616 Guadalupe St, 6th Floor, Austin, TX 78701 (Kimberly.email@example.com).
Disclosure: No funding was received in support of this work.
No conflicts of interest exist with respect to this article.