In the healthcare industry, pay for performance (P4P), also known as “value–basedpurchasing”, is a payment model that offers financial incentives to physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures.

In the United States, most professional medical societies have been nominally supportive of incentive programs to increase the quality of health care. However, these organizations also express concern over the choice and validity of measurements of improvement, which may include process measures that do not directly tie to outcomes. The American Medical Association (AMA) has published principles for pay-for performance programs, with emphasis on voluntary participation, data accuracy, positive incentives and fostering the doctor-patient relationship,^[10] and detailed guidelines for designing and implementing these programs.^[11] Positions by other physician organizations question the validity of performance measures, and whether it will preserve an individual physician’s clinical judgement, a patient’s preferences, autonomy…