title: How Financial and Reputational Incentives Can Be Used to Improve Medical Care.
abstract: OBJECTIVE
  Narrative review of the impact of pay-for-performance (P4P) and public reporting (PR) on health care outcomes, including spillover effects and impact on disparities.
  
  
  RESULTS
  The impact of P4P and PR is dependent on the underlying payment system (fee-for-service, salary, capitation) into which these schemes are introduced. Both have the potential to improve care, but they can also have substantial unintended consequences. Evidence from the behavioral economics literature suggests that individual physicians will vary in how they respond to incentives. We also discuss issues to be considered when including patient-reported outcome measures (PROMs) or patient-reported experience measures into P4P and PR schemes.
  
  
  CONCLUSIONS
  We provide guidance to payers and policy makers on the design of P4P and PR programs so as to maximize their benefits and minimize their unintended consequences. These include involving clinicians in the design of the program, taking into account the payment system into which new incentives are introduced, designing the structure of reward programs to maximize the likelihood of intended outcomes and minimize the likelihood of unintended consequences, designing schemes that minimize the risk of increasing disparities, providing stability of incentives over some years, and including outcomes that are relevant to patients' priorities. In addition, because of the limitations of PR and P4P as effective interventions in their own right, it is important that they are combined with other policies and interventions intended to improve quality to maximize their likely impact.
authors.affiliation: Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Robinson Way, Cambridge CB2 0SR, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Roland
authors.affiliation: Center for Healthcare Value, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA.
authors.forename: R Adams
authors.initials: RA
authors.lastname: Dudley
mesh_terms: D018588:Fee-for-Service Plans / Q000191:economics; D006302:Health Services Research; D006801:Humans; D009042:Motivation; D010820:Physicians / Q000191:economics*; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D012052:Reimbursement, Incentive / Q000191:economics*; D012456:Salaries and Fringe Benefits / Q000191:economics*
keywords: Incentives in health care; quality improvement; quality of care; report cards