The Effect of Financial Incentives on Hospitals That Serve Poor Patients

Background: Providing financial incentives to hospitals to improve quality is increasingly common, yet its effect on hospitals that care for poor patients is largely unknown. Objective: To determine how financial incentives for quality per-formance affect hospitals with more poor patients compared with those with fewer poor patients. Design: Retrospective study. Setting: U.S. hospitals. Participants: 251 hospitals that participated in the Premier Hospital Quality Incentive Demonstration program and a national sample of 3017 hospitals. Measurements: The association between the disproportionate-share index, a marker of caring for poor patients, and baseline quality performance, changes in performance, and terminal perfor-mance for acute myocardial infarction, congestive heart failure, an