A pediatric-focused review of the performance incentive literature

This article seeks to provide a pediatric-focused review of the performance incentive literature. The article will begin with an overview of the performance incentive literature within and outside of healthcare. The review will then detail the pediatric-specific literature, reflect on the breadth and focus of this literature compared with that for adult programs in medicine and school/teacher accountability efforts, and identify three concerning knowledge gaps.

The pediatric performance incentive literature is small, totaling five empirical studies. This literature indicates that performance incentives alone have not been effective at improving incentivized aspects of pediatric healthcare. Only one study evaluates whether pediatric performance incentives improve healthcare for children with significant health conditions. No studies investigate whether this strategy yields negative unintended consequences for children and adolescents or how risk adjustment can augment pediatric performance incentive efforts or attenuate unintended effects.

If approached to participate in or inform performance incentive efforts, pediatricians should appreciate the limitations of the existing empirical literature and ask proponents about their plans for monitoring and/or guarding against potentially negative unintended consequences. Numerous stakeholders are optimistic that this strategy will improve healthcare quality, but the empirical evidence suggests that skepticism is appropriate.