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Pay for performance: is it ethical?

Susan J Taub1

  • 1Northwestern University, Chicago, IL, USA.

Comprehensive Ophthalmology Update
|January 19, 2008
PubMed
Summary
This summary is machine-generated.

Pay for performance in medicine conflicts with physician altruism and the Hippocratic oath. This model may create power imbalances and lead to ethical abuses in healthcare.

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Area of Science:

  • Medical Ethics
  • Health Policy
  • Physician Motivation

Background:

  • The implementation of pay for performance (P4P) in medicine has sparked debate regarding its effectiveness and ethical implications.
  • Traditional physician motivation stems from ideals like altruism and community concern, which are central to the Hippocratic oath.
  • The physician autonomy model, focused on shared decision-making for positive patient outcomes, is gaining traction.

Purpose of the Study:

  • To examine the philosophical and psychological impacts of pay for performance on medical practice.
  • To analyze the potential conflicts between P4P and established medical ethics and physician motivators.
  • To explore the risks associated with integrating P4P into healthcare delivery systems.

Main Methods:

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  • Philosophical analysis of P4P principles in relation to medical ethics.
  • Psychological examination of physician motivation and autonomy.
  • Review of research from the corporate sector on productivity-driven models.

    • Main Results:

    • Pay for performance fundamentally opposes the altruistic principles inherent in the Hippocratic oath.
    • P4P may undermine the physician autonomy model, potentially creating a detrimental power imbalance between patients and clinicians.
    • Adoption of P4P may foster a hyper-productive culture, increasing risks of addictive behaviors and ethical misconduct in healthcare.

    Conclusions:

    • The core tenets of pay for performance are philosophically incompatible with the traditional ethical framework of medicine.
    • Implementing P4P could erode physician altruism and patient-physician relationships, leading to negative consequences.
    • Healthcare systems must carefully consider the psychological and ethical ramifications before widespread adoption of P4P.