Pay for performance: is it the best way to improve control of hypertension?

Pay-for-performance schemes provide financial incentives to health care providers for achieving specified performance targets, and therefore seek to explicitly link physician pay to the quality of care provided for patients. This article provides an overview of the essential elements of pay-for-performance schemes and how these relate to the treatment of hypertension. It also reviews the evidence for the effectiveness of pay-for-performance schemes and analyzes new data from a program in the United Kingdom that provides financial incentives for family practitioners caring for 6 million hypertensive patients. Although several pay-for-performance schemes have proved effective at improving quality of care, few to date have addressed patients with hypertension. Findings from the UK pay-for-performance scheme suggest that generous financial incentives are associated with high levels of achievement for aspects of care for hypertensive patients, but much of this achievement may be attributable to other quality improvement initiatives.