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Pay-for-virtue: an option to improve pay-for-performance?
Stephen Buetow1, Vikki Entwistle
1Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand. s.buetow@auckland.ac.nz
Journal of Evaluation in Clinical Practice
|July 30, 2011
Summary
Pay-for-performance incentives may undermine healthcare professionals' virtuous motivation. Alternative "pay-for-virtue" models could foster intrinsic motivation by rewarding ethical practice and individualized patient care.
Area of Science:
- Medical Ethics
- Healthcare Management
- Professional Motivation
Background:
- Pay-for-performance (PFP) schemes incentivize standardized healthcare behaviors.
- These PFP models risk devaluing virtue-based professional motivation and neglecting individualized patient needs.
Purpose of the Study:
- To explore the potential of "pay-for-virtue" (PFV) as an alternative or supplement to PFP.
- To investigate how PFV could mitigate the negative impacts of PFP on professional virtue and motivation.
Main Methods:
- Conceptual analysis of PFP and virtue ethics in healthcare.
- Proposal of PFV mechanisms, including checks on PFP appropriateness and payment for virtue indicators.
- Identification of potential virtue indicators based on universal virtues and practice analysis.
Main Results:
- PFP may inadvertently erode intrinsic motivation and neglect the importance of professional virtues.
- PFV could potentially realign incentives with virtuous practice and patient-centered care.
- Assessing virtue for payment purposes presents significant challenges.
Conclusions:
- PFV offers a potential strategy to counteract the detrimental effects of PFP on professional virtue.
- Further research is essential to investigate the feasibility, effectiveness, and broader implications of PFV models.
- Careful design and implementation are crucial to ensure PFV strengthens, rather than undermines, intrinsic motivation for good practice.
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