Working Paper: NBER ID: w14886
Authors: Kathleen J. Mullen; Richard G. Frank; Meredith B. Rosenthal
Abstract: 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.
Keywords: Pay-for-performance; Healthcare quality; Incentives; Quality improvement
JEL Codes: D23; H51; I12
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| P4P programs (I38) | clinical quality measures (L15) |
| size of expected reward (D80) | effect size of P4P programs on clinical measures (C90) |
| P4P programs (I38) | cervical cancer screening (I14) |
| P4P programs (I38) | appropriate asthma medication (Y60) |
| P4P programs (I38) | overall effectiveness of P4P (G35) |
| P4P programs (I38) | positive spillover effects on other quality measures (C31) |