Sunday, December 03, 2006

A Devil’s Bargain

A hot subject in health care these days is something called Pay for Performance, which has been given the clever acronym of P4P.

P4P is a scheme whereby health insurance pays higher rates to providers - mainly hospitals and doctors - who meet certain performance standards.

Providers have gone along, apparently being allured by the possibility of increasing their income.

It sounds like a good idea all around, but there is a catch.

Over the years, health care providers have been seen as dedicated professionals who can be trusted to do the right thing. That image has given them high social status, a great deal of independence, generous financial support, and more than a little power.

But they seem not to realize that the message implicit in P4P is that they can’t be counted on to do the right thing unless they get paid extra.

The risk is that once that comes to be realized, much of the justification for their status, independence, generous support and power will have been lost.

And the ironic thing is that the amount of money involved in P4P is not all that much.

It’s a devil’s bargain.

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