title: Pay-for-performance--can it work in Canada?
abstract: Physician reimbursement in Canada has been dominated by pay-for-volume which leads to high utilization. The concern is that this does not promote attention to quality issues that are known to affect health services. However, the evidence that pay-for-quality works is weak, despite the logic of the approach. Also, pay-for-quality methods that seem to work in primary care may not be appropriate in specialties such as surgery. Canada offers opportunities to assess the effect of pay-for-performance in several areas. Developing primary care networks are attractive locations to study the effect of pay-for-quality, perhaps even in a randomized trial. Specialized high-volume surgical programs, such as the Alberta arthroplasty pilot project, might be study of pay-for-participation, in a partnership of providers and sponsors.
authors.affiliation: Academic Affairs, Capital Health, Edmonton.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Feasby
authors.forename: Cindy
authors.initials: C
authors.lastname: Gerdes
mesh_terms: D002170:Canada; D006801:Humans; D009313:National Health Programs / Q000458:organization & administration*; D010816:Physician Incentive Plans / Q000458:organization & administration*; D019984:Quality Indicators, Health Care / Q000458:organization & administration; D011787:Quality of Health Care / Q000458:organization & administration*; D012052:Reimbursement, Incentive / Q000458:organization & administration*