Does pay-for-performance improve the quality of health care?

This paper reviewed empirical studies that assessed the relationship between explicit financial incentives and the provision of high-quality health care. Thirteen of 17 studies examined the effect of incentives on process-of-care quality measures. Five of the 6 studies of physician-level financial incentives and 7 of the 9 studies of provider group-level financial incentives found partial or positive associations with measures of quality. One of the 2 studies of incentives at the payment-system level found a positive effect on access to care. In all, 4 studies suggested unintended effects of incentives