Pay-for-performance Programs to Reduce Racial/Ethnic Disparities

What Might Different Designs Achieve?

Published In: Journal of Health Care for the Poor and Underserved, v. 23, no. 1, Feb. 2012, p. 144-160

Posted on RAND.org on February 01, 2012

by Joel S. Weissman, Romana Hasnain-Wynia, Robin M. Weinick, Raymond Kang, Christine Vogeli, Lisa I Iezzoni, Mary Beth Landrum

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Pay-for-performance (P4P) programs may have unintended effects on racial/ethnic disparities. We used patient-level quality scores from the Hospital Quality Alliance and ranked hospitals by overall quality and by racial/ethnic disparities. We then modeled the effects of different P4P designs on national disparity scores. The models using overall quality to rank hospitals resulted in modest reductions in national disparity scores, although these were smaller than the reductions that were found from programs using disparities to rank hospitals. These results suggest that many hospitals treat Whites and minorities equitably. Nevertheless, in order to maximize both improvements in quality and reductions in national disparities, P4P programs should consider an approach that considers both overall quality and reductions in disparities when setting incentives.

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