Can you get what you pay for? Pay-for-performance and the quality of healthcare providers

Rand J Econ. 2010 Spring;41(1):64-91. doi: 10.1111/j.1756-2171.2009.00090.x.


Despite the popularity of pay-for-performance (P4P) among health policymakers and private insurers as a tool for improving quality of care, there is little empirical basis for its effectiveness. We use data from published performance reports of physician medical groups contracting with a large network HMO to compare clinical quality before and after the implementation of P4P, relative to a control group. We consider the effect of P4P on both rewarded and unrewarded dimensions of quality. In the end, we fail to find evidence that a large P4P initiative either resulted in major improvement in quality or notable disruption in care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Delivery of Health Care / economics*
  • Health Services Accessibility / economics*
  • Humans
  • Models, Theoretical
  • Quality Assurance, Health Care / economics*
  • Quality Assurance, Health Care / statistics & numerical data
  • Reimbursement, Incentive / economics*
  • United States