Pay-for-performance (P4P) is a popular means of incentivising behaviour change. As a result, P4P or contingent rewards are ubiquitously applied by people in a variety of settings, from parents rewarding their children for examination success, to employee remuneration packages in the workplace, to payments for healthcare or other organisations achieving quality targets. The issue of P4P in healt...

Despite their superficial logic, systems of merit pay or pay for performance have features that are toxic to systemic improvement. Contingent rewards doled out by supervisors cause decreased focus on customer needs, loss of accurate information about defects and improvement opportunities, avoidance of stretch goals, and decreased innovation. They may also erode teamwork. Pay for performance may...

Despite a considerable investment of resources into pay for performance, preliminary studies have found that it may not be significantly more effective in improving health outcome measures when compared with voluntary quality improvement programs. Because patient behaviors ultimately affect health outcomes, I would propose a novel pay-for-performance program that rewards patients directly for a...