YOU'RE FIRED! PAY FOR PERFORMANCE PROGRAMS' IMPACT ON PHYSICIAN DECISIONS REGARDING PATIENT RELATIONSHIPS

摘要

Pay for performance programs (P4P) are a type of outcome-based incentive systems designed to shape physician behavior to meet specific performance metrics with the goal of improving health care quality and reducing costs. An expected unintended consequence of P4P is physicians, in order to meet the performance metrics, may engage in patient selection processes such as terminating non-compliant patients, dumping the sickest patients, or trying to asses a potential patient's likelihood of success before accepting a patient into the practice. A gap in the incentive and customer prioritization literature is an explanation on why some service providers will continue providing the same level of service even if the incentive/compensation structure makes specific customers not profitable or less profitable. Based on the view that healthcare is a service, this research seeks to conceptualize a framework for understanding the factors that influence physician-patient relationship decisions for existing patients made after the implementation of pay-for-performance programs.