Pay for Performance in Primary Care in England and California: Comparison of Unintended Consequences

The Article in Brief

Pay for Performance in Primary Care in England and California: Comparison of Unintended Consequences

Ruth McDonald and colleagues

Background In order to improve health care quality, payers are increasingly using financial incentives to reward doctors and medical groups that meet specific performance targets. This study examines the effects of financial incentives in England and California to understand how differences between the programs influence their impact in primary care settings.

What This Study Found Both programs had unintended consequences, but these differed between the programs. English doctors were more likely to report that the incentive program, which has more performance measures and more use of computerized reminders, changed the nature of the office visit. California doctors were more likely to express resentment about pay for performance and appeared less motivated to act on financial incentives, even in the program with the highest rewards.

Implications

• Unintended consequences of incentive programs relate to the way in which these programs are designed and implemented.
• Although unintended, these consequences are not necessarily unpredictable.
• When designing incentive plans, more attention needs to be paid to factors that could produce unintended consequences.