Can You Get What You Pay For?

Pay-For-Performance and the Quality of Healthcare Providers

Kathleen J. Mullen, Richard G. Frank, Meredith B. Rosenthal

Published Apr 13, 2009

Despite the popularity of pay-for-performance (P4P) among health policymakers and private insurers as a tool for improving quality of care, there is little empirical basis for its effectiveness. The authors use data from published performance reports of physician medical groups contracting with a large network HMO to compare clinical quality before and after the implementation of P4P, relative to a control group. They consider the effect of P4P on both rewarded and unrewarded dimensions of quality. In the end, they fail to find evidence that a large P4P initiative either resulted in major improvement in quality or notable disruption in care.

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Mullen, Kathleen J., Richard G. Frank, and Meredith B. Rosenthal, Can You Get What You Pay For? Pay-For-Performance and the Quality of Healthcare Providers. Santa Monica, CA: RAND Corporation, 2009. https://www.rand.org/pubs/working_papers/WR680.html.
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