High quality care and ethical pay-for-performance: a Society of General Internal Medicine policy analysis

J Gen Intern Med. 2009 Jul;24(7):854-9. doi: 10.1007/s11606-009-0947-3. Epub 2009 Mar 18.


Background: Pay-for-performance is proliferating, yet its impact on key stakeholders remains uncertain.

Objective: The Society of General Internal Medicine systematically evaluated ethical issues raised by performance-based physician compensation.

Results: We conclude that current arrangements are based on fundamentally acceptable ethical principles, but are guided by an incomplete understanding of health-care quality. Furthermore, their implementation without evidence of safety and efficacy is ethically precarious because of potential risks to stakeholders, especially vulnerable patients.

Conclusion: We propose four major strategies to transition from risky pay-for-performance systems to ethical performance-based physician compensation and high quality care. These include implementing safeguards within current pay-for-performance systems, reaching consensus regarding the obligations of key stakeholders in improving health-care quality, developing valid and comprehensive measures of health-care quality, and utilizing a cautious evaluative approach in creating the next generation of compensation systems that reward genuine quality.

MeSH terms

  • Ethics, Medical*
  • Humans
  • Insurance, Health, Reimbursement / economics
  • Internal Medicine / economics*
  • Organizational Policy*
  • Physician Incentive Plans / economics*
  • Program Development
  • Quality of Health Care*
  • Societies, Medical*
  • United States