The Unintended Consequences of Pay-for-Performance Programs

Armen Hareyan's picture

At a time when pay-for-performance programs are proliferating, this study finds that while such programs may succeed in improving clinical outcomes and increasing physician income, they also change the nature of patient consultations and the way doctors and nurses work together.

In-depth interviews with 41 family physicians and nurses working in the United Kingdom three years after implementation of a new pay-for-performance initiative revealed that participants believed the aims of the program had been met in terms of improvements in disease-specific processes of patient care and physician income, as well as improved data capture.


Participants also reported unintended consequences of the program, including reduced continuity of care and care fragmentation.

While acknowledging the positive impact of the program, many physicians expressed concern that the guideline-driven process of care leaves them feeling they are becoming less skilled, are losing their sense of place in the enterprise and are less connected with patients.

The Experience of Pay for Performance in English Family Practice: A Qualitative Study
By Stephen M. Campbell, Ph.D., et al


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