Unintended Consequences: Getting the Most While Avoiding the Worst (Pay FOR PERFORMANCE‪)‬

This year we examined a variety of issues that complicate a seemingly straightforward and intuitive premise: pay should somehow be tied to performance. The pay-for-performance experience, both in the United States and abroad, has identified a number of unintended consequences that should be considered by those advocating specific pay-for-performance approaches. One study reviewed (through PubMed) 3,256 articles published over the last 15 years that address the relationship between financial incentives and high-quality healthcare; the review yielded only 17 studies that provide empiric results allowing a reasonable comparison of financial incentives to no incentives (Peterson et al. 2006). Four of those studies showed unintended consequences.