BMJ  2008;336:306-308 (9 February), doi:10.1136/bmj.39463.454815.94

Analysis

Payment for performance in health care

¹ Centre for Health and Public Services Management, University of York, York YO10 5DD, ² Social Dimensions of Health Institute, Universities of Dundee and St Andrews

Debates about performance related pay seem to have moved on from whether it is desirable to how to make it work. But Russell Mannion and Huw Davies cautionthat we still don’t know enough about the potential problems

The first 150 words of the full text of this article appear below.

Health service pay is top of the political and media agenda in many countries. In the UK, moral outrage over doctors’ pay - fuelled by the lay media - has contributed to a widespread belief that pay rises have soaked up much of the recent investment in the NHS.¹ Doctors’ representatives respond that rising pay reflects rising quality and performance, but doubts remain and even the government has expressed alarm, threatening to cap future rises. Other countries are also grappling with how to pay healthcare professionals, particularly doctors.

Pay and performance

Many countries have linked the remuneration problem with concerns about quality and performance, focusing new attention on payment for performance programmes. Under these programmes a portion of payment is dependent on performance assessed against one or more defined measures.² The United States has over 100 private and federal Medicare reward and incentive programmes,³ and Italy and New Zealand are beginning to reward . . . [Full text of this article]

Box 1 Why link financial rewards to quality and performance?

Design elements of pay for performance systems

Objectives
Unit of assessment
Performance measures
Analysis and interpretation of performance data
Performance standards
Financial rewards

Current knowledge

Getting benefits without problems

Box 2 Potential unintended effects of pay for performance
Box 3 Building evidence on good and bad effects

Drawing conclusions

Summary points

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