Research Article: Can Pay-for-Performance Improve Quality and Reduce Health Disparities?

Date Published: June 12, 2007

Publisher: Public Library of Science

Author(s): Katie Coleman, Richard Hamblin

Abstract: The authors discuss a new study that examined whether pay-for-performance improves or worsens existing disparities in health between ethnic groups.

Partial Text: Pay-for-performance programs have been embraced by United States and United Kingdom policy makers and payors (those who pay for health-care services) as a means to improve the quality of health care. In fact, since the Institute of Medicine’s 2001 report Crossing the Quality Chasm suggested realigning incentives to improve care [1], the UK’s National Health Service (NHS) introduced pay-for-performance (P4P) contracts for all family practitioners. In the US, more than half of commercial health maintenance organizations have started using such contracts, and recent legislation requires that the Centers for Medicare and Medicaid Services do the same for Medicare [2].

In a new study published in PLoS Medicine, Christopher Millett and colleagues more fully explore the link between health disparities and P4P [6]. The authors provide the first look at the differential impact of the NHS P4P program on patients with diabetes from different ethnic groups, including black Caribbean, black African, Indian, Pakistani, Bangladeshi, white Irish, and white British.

As major P4P projects such as Medicaid programs and others begin [7], we have the opportunity to integrate important lessons learned. Early evidence does not support the position of some commentators who believed P4P could be a “silver bullet” to improve health-care quality and reduce costs [8]. Instead, as Millett and colleagues show, P4P alone may not be able to drive equitable improvement in health-care quality.



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