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J Gen Intern Med. 2009 Jul;24(7):854-9. doi: 10.1007/s11606-009-0947-3. Epub 2009 Mar 18.

High quality care and ethical pay-for-performance: a Society of General Internal Medicine policy analysis.

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  • 1Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, 6th Floor, Boston, MA 02114, USA. jwharam@partners.org

Abstract

BACKGROUND:

Pay-for-performance is proliferating, yet its impact on key stakeholders remains uncertain.

OBJECTIVE:

The Society of General Internal Medicine systematically evaluated ethical issues raised by performance-based physician compensation.

RESULTS:

We conclude that current arrangements are based on fundamentally acceptable ethical principles, but are guided by an incomplete understanding of health-care quality. Furthermore, their implementation without evidence of safety and efficacy is ethically precarious because of potential risks to stakeholders, especially vulnerable patients.

CONCLUSION:

We propose four major strategies to transition from risky pay-for-performance systems to ethical performance-based physician compensation and high quality care. These include implementing safeguards within current pay-for-performance systems, reaching consensus regarding the obligations of key stakeholders in improving health-care quality, developing valid and comprehensive measures of health-care quality, and utilizing a cautious evaluative approach in creating the next generation of compensation systems that reward genuine quality.

PMID:
19294471
[PubMed - indexed for MEDLINE]
PMCID:
PMC2695523
Free PMC Article
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