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Can You Get What You Pay For? Pay-For-Performance and the Quality of Healthcare Providers

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  • 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.

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Bibliographic Info

Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 14886.

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Date of creation: Apr 2009
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Publication status: published as Kathleen J. Mullen & Richard G. Frank & Meredith B. Rosenthal, 2010. "Can you get what you pay for? Pay-for-performance and the quality of healthcare providers," RAND Journal of Economics, RAND Corporation, vol. 41(1), pages 64-91.
Handle: RePEc:nbr:nberwo:14886

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  1. Gneezy, U. & Rustichini, A., 1998. "Pay Enough - Or Don't Pay at All," Discussion Paper 1998-57, Tilburg University, Center for Economic Research.
  2. David Dranove & Daniel Kessler & Mark McClellan & Mark Satterthwaite, 2003. "Is More Information Better? The Effects of "Report Cards" on Health Care Providers," Journal of Political Economy, University of Chicago Press, vol. 111(3), pages 555-588, June.
  3. Glied, Sherry & Zivin, Joshua Graff, 2002. "How do doctors behave when some (but not all) of their patients are in managed care?," Journal of Health Economics, Elsevier, vol. 21(2), pages 337-353, March.
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Cited by:
  1. Simon Burgess & Carol Propper & Marisa Ratto & Emma Tominey, 2004. "Incentives in the Public Sector: Evidence from a Government Agency," The Centre for Market and Public Organisation 04/103, Department of Economics, University of Bristol, UK.
  2. Richard G. Frank, 2005. "The health care challenge: some perspectives from behavioral economics," Conference Series ; [Proceedings], Federal Reserve Bank of Boston, vol. 50(Jun), pages 61-75.
  3. C. Kirabo Jackson & Henry S. Schneider, 2013. "Reducing Moral Hazard in Employment Relationships: Experimental Evidence on Managerial Control and Performance Pay," NBER Working Papers 19645, National Bureau of Economic Research, Inc.
  4. Jeannette Brosig-Koch & Heike Hennig-Schmidt & Nadja Kairies & Daniel Wiesen, 2013. "How Effective are Pay-for-Performance Incentives for Physicians? – A Laboratory Experiment," Ruhr Economic Papers 0413, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
  5. Dusheiko, Mark & Gravelle, Hugh & Martin, Stephen & Rice, Nigel & Smith, Peter C., 2011. "Does better disease management in primary care reduce hospital costs? Evidence from English primary care," Journal of Health Economics, Elsevier, vol. 30(5), pages 919-932.
  6. Iezzi, Elisa & Lippi Bruni, Matteo & Ugolini, Cristina, 2014. "The role of GP's compensation schemes in diabetes care: Evidence from panel data," Journal of Health Economics, Elsevier, vol. 34(C), pages 104-120.
  7. Eijkenaar, Frank & Emmert, Martin & Scheppach, Manfred & Schöffski, Oliver, 2013. "Effects of pay for performance in health care: A systematic review of systematic reviews," Health Policy, Elsevier, vol. 110(2), pages 115-130.
  8. G. Fiorentini & M. Lippi Bruni & C. Ugolini, 2012. "GPs and hospital expenditures. Should we keep expenditure containment programs alive?," Working Papers wp829, Dipartimento Scienze Economiche, Universita' di Bologna.
  9. Frank Eijkenaar, 2013. "Key issues in the design of pay for performance programs," The European Journal of Health Economics, Springer, vol. 14(1), pages 117-131, February.
  10. Grant Miller & Kimberly Singer Babiarz, 2013. "Pay-for-Performance Incentives in Low- and Middle-Income Country Health Programs," NBER Working Papers 18932, National Bureau of Economic Research, Inc.
  11. Lorens A. Helmchen & Anthony T. Lo Sasso, 2010. "How sensitive is physician performance to alternative compensation schedules? Evidence from a large network of primary care clinics," Health Economics, John Wiley & Sons, Ltd., vol. 19(11), pages 1300-1317.
  12. Lewis, Maureen & Pettersson, Gunilla, 2009. "Governance in health care delivery : raising performance," Policy Research Working Paper Series 5074, The World Bank.
  13. Keser, Claudia & Schnitzler, Cornelius, 2013. "Money talks: Paying physicians for performance," Center for European, Governance and Economic Development Research Discussion Papers 173, University of Goettingen, Department of Economics.
  14. David M. Cutler, 2005. "What is good care, and what is bad?," Conference Series ; [Proceedings], Federal Reserve Bank of Boston, vol. 50(Jun), pages 46-59.
  15. William D. Nordhaus, 2005. "Costs, benefits, and rationing of health care: comments on Cutler’s “What Is Good Care, and What Is Bad?”," Conference Series ; [Proceedings], Federal Reserve Bank of Boston, vol. 50(Jun), pages 77-87.

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