The potential impact of performance incentive programs on racial disparities in healthcare

Abstract

Performance incentive programs-in the form of pay-for-performance and public reporting-are receiving national and international attention. This chapter defines these programs and describes their basic features. It then outlines potential mechanisms by which these programs may impact racial and ethnic disparities in healthcare in a neutral, narrowing, or widening manner. It goes on to review the small body of literature evaluating whether performance incentive programs work, and the even smaller literature regarding how they impact disparities. It finds that performance incentive programs do not necessarily work, and that they can negatively impact disparities. The chapter then considers how particular aspects of program design should be approached with disparity-reducing goals in mind and provides a list of recommendations. It advocates that programs and research evaluate incentive programs for their intended effect, as well as for their unintended effect on disparities. Performance incentive programs are in their infancy-testing whether and how they impact racial and ethnic minorities will promote the design and implementation of programs that eliminate disparities as a part of raising quality. © 2007 Humana Press Inc.