The Potential Impact of Performance Incentive Programs on Racial Disparities in Health Care

Abstract

Performance incentive programs – also known as pay-for-performance, public reporting, and value-based purchasing programs – continue to receive national attention. Although these programs have become even more diverse, their basic features have not changed and the potential mechanisms by which these programs may impact racial and ethnic disparities in health care in a neutral, narrowing, or widening manner remain the same. We repeated the systematic search of the literature for the 4 intervening years since the last edition of this book. We found that although hundreds of articles continue to be written on this subject each year, there were no additions to the empirical evidence regarding the impact of performance incentive program on disparities. While the 2009 Patient Protection and Affordable Care Act will significantly alter the American healthcare landscape, recommendations regarding particular aspects of program design should be approached with disparity-reducing goals in mind that also remain unchanged and may be somewhat more achievable. Given the changing landscape, it is even more important that incentive programs are evaluated for their intended effect, as well as for their unintended effect on racial/ethnic disparities in health care.