Healthcare policy makers and payers around the world are currently experimenting with how to assure and improve the quality of healthcare systems. In recent years, some government and commercial payers have developed P4P mechanisms, which reimburse organisations for achieving and maintaining performance objectives. This trend represents a fundamental shift away from other healthcare payment systems in which reimbursement tends to be based on the quantity of services instead of health system quality.
The United Kingdom is the global forerunner at developing and implementing P4P in primary care. The United States is the leader in secondary hospital care, with several large P4P schemes in place in which hospitals receive bonuses for reporting and in some cases, achieving, key quality targets. Neither system, however, has yet managed to develop a programme that incorporates the full spectrum of patient care.
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