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Published in: Journal of General Internal Medicine 7/2009

Open Access 01-07-2009 | Editorial

The Risks of Rewards in Health Care: How Pay-for-performance Could Threaten, or Bolster, Medical Professionalism

Author: Matthew K. Wynia, MD, MPH

Published in: Journal of General Internal Medicine | Issue 7/2009

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Excerpt

Pay-for-performance incentive programs are born of attempts to answer the following question: How can we pay health-care professionals, and doctors in particular, so that they will be motivated to provide high-quality care? …
Literature
1.
go back to reference Shaw B. The Doctor’s Dilemma, with Preface on Doctors. New York: Brentano’s; 1909. Shaw B. The Doctor’s Dilemma, with Preface on Doctors. New York: Brentano’s; 1909.
2.
go back to reference Hemenway D, Killen A, Cashman SB, Parks CL, Bicknell WJ. Physicians’ responses to financial incentives. Evidence from a for-profit ambulatory care center. N Engl J Med. 1990;322(15):1059–63.PubMedCrossRef Hemenway D, Killen A, Cashman SB, Parks CL, Bicknell WJ. Physicians’ responses to financial incentives. Evidence from a for-profit ambulatory care center. N Engl J Med. 1990;322(15):1059–63.PubMedCrossRef
3.
go back to reference Rodwin MA. Medicine, Money and Morals: Physicians’ conflicts of interest. New York: Oxford University Press; 1993. Rodwin MA. Medicine, Money and Morals: Physicians’ conflicts of interest. New York: Oxford University Press; 1993.
4.
go back to reference Wynia MK. The Oregon capitation initiative: Lessons and warnings from the forefront of the backlash. JAMA. 1996;276(17):1441–4.PubMedCrossRef Wynia MK. The Oregon capitation initiative: Lessons and warnings from the forefront of the backlash. JAMA. 1996;276(17):1441–4.PubMedCrossRef
5.
go back to reference Applbaum AI. Doctor, schmoctor: Practice positivism and its complications. In: Baker RB, Caplan AL, Emanuel LL, Latham SR, eds. The American Medical Ethics Revolution. Baltimore, MD: Johns Hopkins University Press; 1999. Applbaum AI. Doctor, schmoctor: Practice positivism and its complications. In: Baker RB, Caplan AL, Emanuel LL, Latham SR, eds. The American Medical Ethics Revolution. Baltimore, MD: Johns Hopkins University Press; 1999.
6.
go back to reference Davis K, Cooper BS. American health care: Why so costly? The Commonwealth Fund. Invited testimony for the US Senate Appropriations Subcommittee. June 11, 2003. Davis K, Cooper BS. American health care: Why so costly? The Commonwealth Fund. Invited testimony for the US Senate Appropriations Subcommittee. June 11, 2003.
8.
go back to reference Smith D. U.S. business leaders say hobbled by health care costs. Reuters Business News, March 14, 2009. Smith D. U.S. business leaders say hobbled by health care costs. Reuters Business News, March 14, 2009.
9.
go back to reference Chervenak FA, McCullough LB. The moral foundation of medical leadership: The professional virtues of the physician as fiduciary of the patient. Am J Obstet Gynecol. 2001;184(5):875–9.PubMedCrossRef Chervenak FA, McCullough LB. The moral foundation of medical leadership: The professional virtues of the physician as fiduciary of the patient. Am J Obstet Gynecol. 2001;184(5):875–9.PubMedCrossRef
10.
go back to reference Wynia MK. The short history and tenuous future of medical professionalism: The erosion of medicine’s social contract. Perspect Biol Med. 2008;51(4):565–78 Autumn.PubMedCrossRef Wynia MK. The short history and tenuous future of medical professionalism: The erosion of medicine’s social contract. Perspect Biol Med. 2008;51(4):565–78 Autumn.PubMedCrossRef
11.
go back to reference Hendrickson MA. Pay for performance and medical professionalism. Q Manage Health Care. 2008;17(1):9–18. Hendrickson MA. Pay for performance and medical professionalism. Q Manage Health Care. 2008;17(1):9–18.
12.
go back to reference Wharam JF, Paasche-Orlow MK, Farber NJ, et al. High quality care and ethical pay for performance: A Society of General Internal Medicine policy analysis. J Gen Intern Med. 2009; doi:10.1007/s11606-009-0947-3. Wharam JF, Paasche-Orlow MK, Farber NJ, et al. High quality care and ethical pay for performance: A Society of General Internal Medicine policy analysis. J Gen Intern Med. 2009; doi:10.​1007/​s11606-009-0947-3.
13.
go back to reference Wynia MK. Physician ethics and participation in quality improvement. In: Jennings B, Baily MA, Bottrell M, Lynn J, eds. Health Care Quality Improvement: Ethical and Regulatory Issues. Garrison, NY: The Hastings Center; 2007. Wynia MK. Physician ethics and participation in quality improvement. In: Jennings B, Baily MA, Bottrell M, Lynn J, eds. Health Care Quality Improvement: Ethical and Regulatory Issues. Garrison, NY: The Hastings Center; 2007.
14.
go back to reference Conrad DA, Perry L. Quality-based financial incentives in health care: Can we improve quality by paying for it. Annu Rev Public Health. 2009;30:357–71.PubMedCrossRef Conrad DA, Perry L. Quality-based financial incentives in health care: Can we improve quality by paying for it. Annu Rev Public Health. 2009;30:357–71.PubMedCrossRef
15.
go back to reference Rosenthal MB. Beyond pay for performance – emerging models of provider-payment reform. N Engl J Med. 2008;359(12):1197–1200.PubMedCrossRef Rosenthal MB. Beyond pay for performance – emerging models of provider-payment reform. N Engl J Med. 2008;359(12):1197–1200.PubMedCrossRef
16.
go back to reference Damberg CL, Raube K, Teleki SS, dela Cruz E. Taking stock of pay-for-performance: A canded assessment from the front lines. Health Affairs. 2009;28(2):517–25.PubMedCrossRef Damberg CL, Raube K, Teleki SS, dela Cruz E. Taking stock of pay-for-performance: A canded assessment from the front lines. Health Affairs. 2009;28(2):517–25.PubMedCrossRef
17.
go back to reference Titmuss RM. The Gift Relationship: From human blood to social policy. The New Press: New York; 1997 (Original edition with new chapters, edited by Oakley A and Ashton J). Titmuss RM. The Gift Relationship: From human blood to social policy. The New Press: New York; 1997 (Original edition with new chapters, edited by Oakley A and Ashton J).
18.
go back to reference Frey BS, Jegen R. Motivation crowding theory: A survey of empirical evidence. J Econ Surveys. 2001;15(5):589–611.CrossRef Frey BS, Jegen R. Motivation crowding theory: A survey of empirical evidence. J Econ Surveys. 2001;15(5):589–611.CrossRef
19.
go back to reference Skinner BF. Science and Human Behavior. New York: The Free Press; 1953. Skinner BF. Science and Human Behavior. New York: The Free Press; 1953.
21.
go back to reference Deci EL, Koestner R, Ryan RM. A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. Psych Bulletin. 1999;125(6):627–668.CrossRef Deci EL, Koestner R, Ryan RM. A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. Psych Bulletin. 1999;125(6):627–668.CrossRef
22.
go back to reference Lazear EP. Personal economics: Past lessons and future directions. J Labor Econ. 1999;17:199–236.CrossRef Lazear EP. Personal economics: Past lessons and future directions. J Labor Econ. 1999;17:199–236.CrossRef
24.
go back to reference Gneezy U, Rustichini A. Pay enough or don’t pay at all. Q J Econ. 2000;115(3):791–810.CrossRef Gneezy U, Rustichini A. Pay enough or don’t pay at all. Q J Econ. 2000;115(3):791–810.CrossRef
25.
go back to reference Gneezy U, Rustichini A. A fine is a price. J Legal Studies. 2000;29(1):1–17.CrossRef Gneezy U, Rustichini A. A fine is a price. J Legal Studies. 2000;29(1):1–17.CrossRef
26.
go back to reference Deci EL, Ryan RM. Self determination theory and the facilitation of intrinsic motivation, social development and well being. Am Psychol. 2000;55(1):68–78.PubMedCrossRef Deci EL, Ryan RM. Self determination theory and the facilitation of intrinsic motivation, social development and well being. Am Psychol. 2000;55(1):68–78.PubMedCrossRef
27.
go back to reference Galvin R. Pay for performance: Too much of a good thing? A conversation with Martin Roland. Health Affairs. 2006;25:w412–419.CrossRef Galvin R. Pay for performance: Too much of a good thing? A conversation with Martin Roland. Health Affairs. 2006;25:w412–419.CrossRef
28.
go back to reference Austin R, Gittell JH. When it should not work, but does: Anomolies of high performance. In: Business Performance Measurement. AD Neely, ed. Cambridge: Cambridge University Press, 2002. Austin R, Gittell JH. When it should not work, but does: Anomolies of high performance. In: Business Performance Measurement. AD Neely, ed. Cambridge: Cambridge University Press, 2002.
29.
go back to reference Lindenauer PK, Remus D, Roman S, et al. Public reporting and pay for performance in hospital quality improvement. N Engl J Med. 2007;356(5):486–96.PubMedCrossRef Lindenauer PK, Remus D, Roman S, et al. Public reporting and pay for performance in hospital quality improvement. N Engl J Med. 2007;356(5):486–96.PubMedCrossRef
30.
go back to reference Doran T, Fullwood C, Gravelle H, Reeves D, Kontopantelis E, et al. Pay-for-performance programs in family practices in the United Kingdom. N Engl J Med. 2006;355:375–84.PubMedCrossRef Doran T, Fullwood C, Gravelle H, Reeves D, Kontopantelis E, et al. Pay-for-performance programs in family practices in the United Kingdom. N Engl J Med. 2006;355:375–84.PubMedCrossRef
31.
go back to reference Frey BS. A constitution for knaves crowds out civic virtues. Economic J. 1997;107(443):1043–53.CrossRef Frey BS. A constitution for knaves crowds out civic virtues. Economic J. 1997;107(443):1043–53.CrossRef
Metadata
Title
The Risks of Rewards in Health Care: How Pay-for-performance Could Threaten, or Bolster, Medical Professionalism
Author
Matthew K. Wynia, MD, MPH
Publication date
01-07-2009
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue 7/2009
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-009-0984-y

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