Patient performance standards: the next bold policy initiative in health care?

Performance standards have become a driver for accountability and quality improvement in health care, sometimes as part of payment-for-performance programmes. This essay discusses the novel concept of performance standards for patients - specifically, standards for enrolled groups - and the option of payments for patient performance. Might these ideas define the next logical step to improve quality in health care and help reduce health inequalities between population groups? After considering some possible arguments for patient performance standards, we suggest what these standards might look like, discuss the main concerns regarding their possible development and use, and indicate how these concerns might be appropriately answered.