Paying for performance in primary medical care: learning about and learning from "success" and "failure" in England and California.
Paying physicians to hit performance targets is becoming increasingly fashionable, as evidenced by the growing number of "pay-for-performance" programs in the United States and beyond. This article compares pay-for-performance initiatives in two nations--the United Kingdom and the United States. It pays particular attention to the context in which the initiatives were conceived and implemented, factors which are largely neglected in the pay-for-performance literature. Despite some glowing reviews of the UK national pay-for-performance program for primary care doctors, we suggest that such programs face significant technical obstacles in all cases and particularly severe institutional obstacles in the United States.
McDonald
Ruth
R
University of Manchester.
White
Joseph
J
Marmor
Theodore R
TR
D019985:Benchmarking; D002140:California; D003431:Cross-Cultural Comparison; D004739:England; D006801:Humans; D016347:Medical Records Systems, Computerized; D015279:Organizational Culture; D010816:Physician Incentive Plans / Q000458:organization & administration*; D011216:Practice Management, Medical / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D013221:State Health Plans / Q000458:organization & administration*; D013222:State Medicine / Q000458:organization & administration*