CMWF-Pay for Performance in Primary Care in England and California: Comparison of Unintended Consequences

The Commonwealth Fund loooked at physicians in California and the United Kingdom that were already participating in pay-for-performance programs. The study found unitended consequences on other aspects of care or on physician motivation. These effects include:

• Encouraging physicians to avoid sicker patients
• Exacerbating disparities
• Neglecting types of care for which quality is not measured

The authors conclude that the unintended consequences of pay-for-performance programs are dependant on the way in which these programs are designed and implemented.