Pay-for-performance programs Do they improve the quality of primary care?

Background The recent release of The Royal Australian College of General Practitioners clinical quality indicators has sparked renewed debate about the role of pay-for-performance (P4P) programs and their potential usefulness in Australian general practice. Objective This article seeks to update recent evidence about the impact of P4P programs on the quality of primary care and presents the evidence based viewpoint that there are potential problems with P4P, which may limit its usefulness. Discussion P4P programs are attractive to hinders as they suggest a theoretical link between provider performance and improvements in healthcare quality - and potentially improved control over costs. Although P4P programs in primary care appear to have an effect on the behaviour of general practitioners, there is little evidence that these programs in their current form improve health outcomes or healthcare system quality. Further research is needed into the effect of these programs on healthcare quality before they are introduced into Australian general practice.