Forget about pay for performance (P4P)

The principles of behavior modification demonstrate the importance of incentives. What is also well documented is that extrinsic rewards, i.e., financial incentives, have limited impact on complex behaviors.  Moreover, extrinsic rewards are most effective with young children. 

Consequently, based on the science of human behavior P4P would result in the desired performance in very limited settings and situations. We should not be surprised by the outcomes that we have experienced by applying P4P to health care...more money is not the answer.  

http://content.healthaffairs.org/content/31/9/1932.abstract?sid=6eb2c26a-18b9-4a35-a1cc-5b44b41c8ca2

When Setting Targets Misses the Mark

The solution to the problems we face in health care are frequently reduced to one sentence pronouncements.  National health care is put forth as the best answer and in the same breath the National Health Service, a la British model is lauded as the way to go. And while that model may have elements we may want to adopt (home visits for parents of newly born infants) we also need to be well aware of its failures.

Today's New York Times on Page 9 describes the recent report which looked at conditions at Stafford Hospital in England from 2005 to 2009 where care became so negligent that, "...patients left unbathed and lying in their own excrement and urine..patients left so thirsty that they drank water from vases..."  It seems that they were trying to meet health service targets and balance the books. While many of the senior managers were let go, the top regional person is now at the helm of the National Health Service in England and it seems that no one lost their license because of the way patients were treated.

There are many lessons to be learned from Stafford hospital.
http://www.nytimes.com/2013/02/07/world/europe/hospital-report-cites-appalling-suffering-in-staffordshire.html