...The second idea that gets short shrift is "pay for performance." Paul Glasziou and colleagues reviewed evidence on the positive and negative effects of financial incentives in changing clinical behaviour and devised a checklist of things to consider before deciding to implement a pay for performance scheme. Interestingly, none of the well known schemes from Australia, the United Kingdom, and the United States tick all the boxes. In an editorial Steffie Woolhandler and colleagues discuss the evidence that such schemes undermine honesty and motivation. Not only do these systems invite "gaming," such as over-investigation to find unimportant comorbidities and "upcoding" of conditions, they may also "undermine the intrinsic motivation crucial to maintaining quality when nobody is looking."
Cite this as: BMJ 2012;345:e5529
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