P4P improves performance in short-term at the expense of other factors.

The results of an English study on the effects of pay-for-performance (P4P) have been published in the New England Journal of Medicine. Although P4P accelerated improvements in quality for two of three chronic conditions in the short term, long-term effects were less pronounced, and quality of care declined for conditions not linked to incentives. The authors analyzed quality of care in 42 representative family practices, with data collected both before and after implementation of P4P in 2004. They found that, between 2003 and 2005, the rate of improvement in quality of care increased for asthma and diabetes (P<0.001) but not for heart disease. By 2007, the rate of improvement had slowed for all three conditions (P<0.001), and the quality of those aspects of care that were not associated with an incentive had declined for patients with asthma or heart disease. Compared to the period before P4P, the improvement rate after 2005 was unchanged for asthma or diabetes and was reduced for heart disease (P=0.02).

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