High quality care and ethical pay-for-performance: a Society of General Internal Medicine policy analysis.

Journal Article (Journal Article)

BACKGROUND: Pay-for-performance is proliferating, yet its impact on key stakeholders remains uncertain. OBJECTIVE: The Society of General Internal Medicine systematically evaluated ethical issues raised by performance-based physician compensation. RESULTS: We conclude that current arrangements are based on fundamentally acceptable ethical principles, but are guided by an incomplete understanding of health-care quality. Furthermore, their implementation without evidence of safety and efficacy is ethically precarious because of potential risks to stakeholders, especially vulnerable patients. CONCLUSION: We propose four major strategies to transition from risky pay-for-performance systems to ethical performance-based physician compensation and high quality care. These include implementing safeguards within current pay-for-performance systems, reaching consensus regarding the obligations of key stakeholders in improving health-care quality, developing valid and comprehensive measures of health-care quality, and utilizing a cautious evaluative approach in creating the next generation of compensation systems that reward genuine quality.

Full Text

Duke Authors

Cited Authors

  • Wharam, JF; Paasche-Orlow, MK; Farber, NJ; Sinsky, C; Rucker, L; Rask, KJ; Figaro, MK; Braddock, C; Barry, MJ; Sulmasy, DP

Published Date

  • July 2009

Published In

Volume / Issue

  • 24 / 7

Start / End Page

  • 854 - 859

PubMed ID

  • 19294471

Pubmed Central ID

  • PMC2695523

Electronic International Standard Serial Number (EISSN)

  • 1525-1497

Digital Object Identifier (DOI)

  • 10.1007/s11606-009-0947-3


  • eng

Conference Location

  • United States