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This document explores how hospital pay for performance (P4P) programs would affect health system performance along nine dimensions. A few studies have found that hospital P4P programs improve the reliability with which appropriate care is provided. How these programs would affect spending, patient experience, and health is uncertain. No published studies estimate how hospital P4P programs will affect waste; P4P programs are not relevant to consumer financial risk, coverage, and capacity. Broad implementation of hospital P4P is technically feasible but will require infrastructure and resources to support implementation and ongoing operations.

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