Pay-for-virtue: an option to improve pay-for-performance?

Pay-for-performance schemes reward standardized professional behaviours associated with effective care. However, they neglect the significance of virtue and devalue and erode professional motivation based on virtue. Pay for training to cultivate virtue, and/or pay-for-virtue, may mitigate these dangers. Although virtue is typically considered its own reward, and the assessment of virtue is problematic, pay-for-virtue could involve (1) stringent checks on the appropriateness of the standardized care currently rewarded by pay-for-performance for individual patients or (2) pay for indicators of virtue. These indicators could be based on virtues identified from a framework of universal virtues and through logical inferences from features of practice. It is possible that pay-for-virtue could ultimately strengthen health professionals' intrinsic motivation for good practice, but this and the broader effects of pay-for-virtue would need careful investigation.

Pay for performance and the revolution in American medical culture.

The recent implementation of pay for performance by CMS in radiology practices is not going to be an isolated event. Instead, it reflects an early manifestation of what will likely be a revolution in how we work and how we are paid in diagnostic imaging. Examining the factors that underly this revolution are critical for understanding the next waves of change that will drive our future.

Pay for performance--a clash of cultures.

Implementation of pay for performance is being widely heralded as a new paradigm. However, the concept is not only alien to physicians, but may be ethically abhorrent, as well.

Pay for performance--for whom the bell tolls.

Pay -for-performance programs require physician oversight and adherence to high ethical standards if they are truly going to succeed.

The dark side of P4P.

Examine the pitfalls of pay for performance and learn why some physicians and others are deeply concerned about the idea of incentive pay and fear it will have a negative impact on patient care.

Financial incentives, cross-purposes, and moral motivation in health care provision.

Financial incentives and disincentives are fundamental to a category of proposals, usually characterised as forms of managed care, whereby the pecuniary interests of health care providers are directly affected by their clinical decision-making. Presently, Australian health care administrators and private insurers are adopting financial incentives as a means of ensuring provider compliance with 'health outcome' and cost-constraint objectives. To the extent that this has occurred, health-care relationships are transformed to emulate, more closely, a commercial transaction. This paper questions the ideological assumptions which inform the use of financial incentives in the health care domain and raises concerns with regard to the potential for financial incentives to undermine the moral integrity of clinical decision-making. It also challenges the legitimacy of rationing health care resources through the use of this measure, particularly when adopted by private insurers of health care.