Patient opinions regarding 'pay for performance for patients'

J Gen Intern Med. 2008 Oct;23(10):1647-52. doi: 10.1007/s11606-008-0739-1. Epub 2008 Jul 29.


Background: Pay for performance (P4P) programs have shown only modest improvements in outcomes and do not target patient behaviors. Many large employers and payers are turning to pay for performance for patients (P4P4P) to reduce health costs and improve the health of their covered populations. How these programs may be perceived by patients is unknown.

Objective: To assess patients' opinion of the acceptability of P4P4P.

Design: Cross-sectional self-administered survey.

Participants: Patients in waiting rooms in two university-based primary care clinics.

Measurements: Participants were asked their opinions about paying people to quit smoking, lose weight, control their blood pressure, or control their diabetes.

Results: Respondents were split on whether P4P4P is desirable. Thirty-six to 42% thought it was a good/excellent idea to pay smokers to quit smoking, obese people to lose weight, people with hypertension to control their blood pressure, or people with diabetes to control their blood sugar, while 41-44% of the sample thought it was a bad/very bad idea. Smokers and patients who were obese endorsed P4P4P more favorably as a means to achieving tobacco cessation and weight loss than their non-smoking and non-obese counterparts.

Conclusions: Acceptance of paying patients for performance by the general population is equivocal. Establishing the efficacy of paying patients for performance may help it gain wider acceptance.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cross-Sectional Studies
  • Female
  • Health Behavior
  • Humans
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care*
  • Patient Satisfaction / economics*
  • Reimbursement, Incentive / economics*
  • Risk-Taking