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Pay for Performance in Medicine

The lead article in the Fall 2006 issue of the University of Minnesota's Bioethics Examiner is entitled "The Impact of Pay-for-Performance Beyond Quality Markers–A Call for Bioethics Research". It's written by David Satin, MD, Assistant Professor in the U's Department of Family Medicine and Community Health, and a postdoctoral fellow in the Center for Bioethics.

The pay-for-performance (P4P) approach to physician reimbursement, which Medicare and Medicaid are about to adopt across the country, pays clinicians more "if their patients score well on a particular set of health care quality markers." Satin proposes the following research questions to investigate potentially serious adverse effects of P4P:

  1. How does P4P affect access to health care?
  2. How does P4P affect patient-centered care?
  3. Will sicker patients get worse care under P4P?
  4. What are the effects of P4P on clinicians and the field of medicine?

He argues that examining these questions "from the perspectives of disciplines such as ethics, psychology, sociology, economics, epidemiology, public health, and clinical medicine is exactly the kind of interdisciplinary research bioethicists ought to be doing." I can't help but agree, and ask rhetorically

  • Where but in a university could such interdisciplinary work be done?
  • Where but in a university are such societally important questions likely to be raised?

This approach to P4P is well on the way to being an exemplary piece of publicly engaged scholarship. What it needs to take it all the way is involvement with health insurers, government agencies, and concerned citizens to fully inform such research and take action on the results.

The Fall issue of Bioethics Examiner is on-line as a downloadable pdf at http://www.bioethics.umn.edu/publications/be/2006/BE-2006-fall.pdf.