Abstract
This paper aims to describe the introduction of pay-for-performance in New Zealand primary health care; compare this policy development with analogous English initiatives; discuss the risk of unintended, adverse consequences of the New Zealand programme; and consider key lessons for the policy development of pay-for-performance in health care. This article is based on description and analysis of policy developments for performance management in New Zealand and England. It is not clear that the New Zealand Programme appropriately reflects the values and goals of primary health care providers. It encourages slow, incremental change by paying bonuses to Primary Health Organisations, rather than practices, for meeting targets on a small number of performance indicators. The bonuses account for a tiny proportion of the total income of PHOs and in general are for service improvement rather than to supplement practitioner incomes. It is important to align performance incentives with stakeholders' values and goals. The paper discusses New Zealand developments in pay-for-performance in the context of English policy initiatives and considers lessons for all health systems.
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