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Health Care Pay for Performance

"Pay for performance" rewards doctors, hospitals, and other health care providers for attaining targeted service goals, like meeting health care quality or efficiency standards. RAND research has explored a range of policy and economic implications related to the use of pay-for-performance delivery models.

Journal Article
Using the Lessons of Behavioral Economics to Design More Effective Pay-for-Performance Programs
Although pay for performance incentives are increasingly popular, the healthcare literature shows that these have had minimal effect. Design improvements in these programs can enhance their effectiveness.
Jul 1, 2010
News Release
Performance-Based Payments for Primary Care Providers May Worsen Disparities in Medical Care
Rewarding primary care physicians for providing better care to patients could end up widening medical disparities experienced by poorer people and by minorities. Increasing the number of primary care physicians is also not enough to boost U.S. health care quality and lower costs.
May 4, 2010
Journal Article
Performance-Based Payments for Primary Care Providers May Worsen Disparities in Medical Care
Rewarding primary care physicians for providing better care to patients could end up widening medical disparities experienced by poorer people and by minorities. Increasing the number of primary care physicians is also not enough to boost U.S. health care quality and lower costs.
May 1, 2010
Journal Article
Physician Compensation, Cost, and Quality
Pay-for-performance, transparency, and other innovative ways of compensating physicians will only work if, at the same time, the system for providing care has clear objectives and specific tools to help physicians achieve those objectives.
Jan 1, 2010
Journal Article
Can You Get What You Pay For? Pay-for-Performance and the Quality of Healthcare Providers
One-liner abstract (description): 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.
Jan 1, 2010
Journal Article
The Effect of Performance-Based Financial Incentives on Improving Patient Care Experiences: A Statewide Evaluation
Pay-for-performance incentives improve physician-patient communication, care coordination, and interaction with office staff.
Dec 1, 2009
Journal Article
Reliability of Patient Responses in Pay for Performance Schemes: Analysis of National General Practitioner Patient Survey Data in England
Assess the robustness of patient responses to a new national survey of patient experience as a basis for providing financial incentives to doctors.
Oct 24, 2009
Report
Hospital Pay for Performance
Researchers explore how hospital pay for performance would affect health system performance with respect to spending, patient experience, health, waste, consumer financial risk, coverage, and capacity.
Oct 12, 2009
Report
Physician Pay for Performance
This document explores how physician pay for performance (P4P) programs would affect health system performance along nine dimensions.
Oct 12, 2009
News Release
Strategies Outlined to Test New Payment Models for Health Care
A new RAND study outlines methods that might be used to test a novel payment system for medical care that would provide doctors, hospitals and other health providers a set fee for treating an ailment such as hip replacement surgery.
Sep 29, 2009
Journal Article
Strategies Outlined to Test New Payment Models for Health Care
A new study outlines methods that might be used to test a novel payment system for medical care that would provide doctors, hospitals and other health providers a set fee for treating an ailment such as hip replacement surgery.
Sep 1, 2009
Report
The Reliability of Provider Profiling: A Tutorial
Although hospitals and managed care facilities have used performance measurement for some time, the focus on doctor profiling by purchasers and health plans is relatively new, bringing to the fore the limitations of available physician data and proving the need for reliability measures in physician profiling.
Jun 25, 2009
Commentary
Quality, Transparency, and the US Government
If the government is demanding transparency of physicians and hospitals, the very least the physicians and hospitals should do is demand transparency of the government, writes Robert Brook.
Apr 1, 2009
Research Brief
Designing Effective Pay-for-Performance in K-12 Education
RAND recommends policy actions and investments to increase the likelihood of success of pay-for-performance systems of educator compensation in the United States and identify the practices most likely to succeed.
Mar 26, 2009
Journal Article
Pay-For-Performance for Medical Groups Stimulates Changes in Practice
A large group of California physicians given financial incentives to improve the quality of medical care have begun to embrace an array of changes important to advancing quality.
Mar 15, 2009
News Release
Pay-For-Performance for Medical Groups Stimulates Changes in Practice
A large group of California physicians given financial incentives to improve the quality of medical care have begun to embrace an array of changes important to advancing quality.
Mar 11, 2009
Journal Article
Pay for Performance in the Hospital Setting: What Is the State of the Evidence?
More than 40 private sector hospital pay-for-performance (P4P) programs now exist, and Congress is considering initiating a Medicare hospital P4P program. Given the growing interest in hospital P4P, this systematic review of the literature examines the current state of knowledge about the effect of P4P on clinical process measures, patient outcomes and experience, safety, and resource utilization.
Jan 15, 2009
Report
California's Workers' Compensation Program Could Model Pay-for-Performance
California's workers' compensation group health program is suitable for three models of a pay-for-performance initiative that include agreed on performance measures, expandable data-collection infrastructure, and incentives in order to ensure physician buy-in.
Jul 1, 2008
Journal Article
Pay for Performance in Behavioral Health
Presents the results of a targeted national effort to identify pay-for-performance programs in behavioral health. Many programs struggled to obtain accurate data on quality and outcomes of care, and public reporting of results was not widespread.
Jan 1, 2008
Journal Article
Financial Incentives for Quality in Breast Cancer Care
Most breast cancer care providers in Los Angeles County outside of staff- or group-model HMOs are not subject to explicit financial incentives based on quality-of-care measures. New approaches are needed to direct incentives toward these specialists.
Jan 1, 2008

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RAND Topic:
Health Care Pay for Performance

Topic Synonyms:
P4P;
Value-Based Purchasing

Research conducted by

RAND Health Care

Researcher Spotlight

Cheryl L. Damberg

Director, RAND Center of Excellence on Health System Performance

Cheryl Damberg is director of the RAND Center of Excellence on Health System Performance, distinguished chair in Health Care Payment Policy, and a principal senior economist at the RAND Corporation. Her research explores the impact of strategies to drive cost and quality improvements in health…
Anagha Alka Tolpadi

Statistical Analyst

Anagha Tolpadi (she/her) is a statistical analyst at the RAND Corporation. She conducts statistical analyses to address research questions in a variety of health policy areas, such as health equity, quality of care, patient satisfaction, and pay-for-performance. She conducts statistical analyses…

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